Mailing Address (No., Street City, County, ST, Zip)
Street Address (No. Street City, County, ST, Zip)
Proprietorship Type Business
Tax Exempt
Partnership Years In Business
Purchase Orders
Corporation Years In Business
No. of Employees
Federal Tax I.D. Number
Principal Owner(s) or Officers
Name Title
SSN
Residence Address
Residence Phone
Name Title
SSN
Residence Address
Residence Phone
Other Business or Principals
Real Estate
Owned Value
Title In Name Of
Balance Owed
Mortgage Co.
Home
Business
Other
Bank Ref
Supplier Reference (MUST BE COMPLETED)
Name
City
ST
Phone
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td colspan="23">Name
City
ST
Phone
Name
City
ST
Phone
Name
City
ST
Phone
All accounts are due and payable at
Weslaco Texas on the 10th day of the month following the prior
months billing and become past due thereafter. If full payment
has not made by the end of the billing cycle, finance charges will
be computed and added to the unpaid balance of 0.5% per month, to
exceed the highest lawful rate, at the time of the billing cycle
immediately following, and accessed each billing cycle until paid.
IF the above information is for the purpose of obtaining merchandise
and material on credit. The undersigned agree as
Guarantors, to guarantee and to be responsible and liable to pay
CENTRAL PLUMBING AND SUPPLY CO; A DIVISION OF CENCO CORPORATION, by
the above named individual, partnership or corporation. The
undersigned further agree that without notice, said indebtedness or
credit may be changed in the form and that no change in partners or
ownership shall affect this guarantee, until Central Plumbing and
Electric Supply Co; A Division on Cenco Corporation, is notified in
writing by certified mail of the intent to be longer held as
Guarantor on future purchases. For the purpose of security
credit from you, I certify that the above information is true and
complete to the best of my knowledge. Applicant authorized you
to check my credit and employment history and to provide and/or
obtain information about credit experience with me.
