MSDS | Perfect Blend

Credit Application

Apply for a credit account with Perfect Blend Organics to streamline your purchases. Complete the form below to get started.

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Heads up: For your security, we don’t include SSNs in the email body. Please provide sensitive info by phone, fax, or secure upload if provided.

Business Information

Business Name

Parent Company

Physical Address

Billing Address

Phone Number

Fax Number

Business Details

Type of Business

Business Established Year

Years in Business

Taxpayer ID#

UBI#

Principals

Principal #1 Full Name

Title

Physical Address

Percentage of Business

Phone Number

Principal #2 Full Name

Title

Physical Address

Percentage of Business

Phone Number

Principal #3 Full Name

Title

Physical Address

Percentage of Business

Phone Number

Insurance

Insurance Company Name

Address

Contact Name

Phone Number

Certificate of Insurance must be provided to prove coverage for rented or leased equipment with a limit high enough to cover all equipment at any point in time, or Damage Waiver will be charged on each rental contract. Perfect Blend LLC must be listed as the Certificate Holder.

Bank Information

Account #

Type of Account

Bank Name

Address

Contact Name

Phone Number

AP / Billing

Contact Name

Phone Number

Email Address

Billing Address or PO Box

PO Required?

Special Billing Instructions

Job Name/Number Required?

Authorized Account Users

Tax Exemption Certificate

Has the business or any principal ever declared bankruptcy?

If yes, Date Filed

Any outstanding judgments?

Trade References

Trade Reference Name #1

Contact Name

Phone Number

Trade Reference Name #2

Contact Name

Phone Number

Trade Reference Name #3

Contact Name

Phone Number

I Understand and Agree to the Following Terms

The Applicant and each person signing below warrants that the information provided is true and correct, authorizing Perfect Blend, LLC to release this information to credit providers and to obtain credit details from banks, credit bureaus, and creditors. Applicant agrees to notify Perfect Blend, LLC of any material changes.

Payment is due upon receipt of the invoice. Delinquent invoices incur a service charge of the lesser of 1.5% per month (18% APR) or the highest rate permitted by law. Applicant submits to the jurisdiction of Washington courts, with venue in King County, and agrees to pay all collection costs, including reasonable attorney fees.

Applicant Signature

Date

Personal Guarantee

Guarantor Signature

Guarantor SSN

Date

Printed Name

Witness Name

Witness Signature

Attach Files Here