Business Credit Reports

Company Information

Company Name

DBA

Address

City

State/Province

Zip/Postal Code

Phone

Fax

Billing Address

Billing City

Billing State/Province

Billing Zip/Postal Code

Tax Identification #

Type of Business

# of Years in Business

Legal Form (Corporation, Partnership, or Proprietorship)

Contact Information

First Name

Last Name

Title

Phone

Bank References

Bank Name

Type of Account (Savings, Checking, Other)

Address

City

State

Zip

Account #

Contact

Phone

Credit Reference #1

Company

Contact

Phone

Fax

Address

Account #

Credit Reference #2

Company

Contact

Phone

Fax

Address

Account #

Credit Reference #3

Company

Contact

Phone

Fax

Address

Account #

Request

Requested Amount

Comments (400 characters max)

Supporting Documentation

If tax exempt or submitting financial statements, please upload those forms here.

Click the Browse / Choose Files button above to select the files you want to send. Then click the Upload button.
Please keep individual file sizes to 4MB or less.

Uploaded Documents

Terms

CREDIT TERMS: Accounts not paid by the 30th of the month are subject to a finance charge of 1.5% per month on the unpaid balance which is 18% per year. Any account 60 or more days past due will revert to a C.O.D. status.

Applicant agrees to pay any collection costs incurred to collect the amount due, including reasonable attorney’s fees. The applicant May/ May Not submit a financial statement. The applicant submitting the containing information as an inducement to grant credit warrants that the information submitted is true and correct. Roppel’s is authorized to investigate the credit references listed, as well as utilize all customary sources of credit information including credit reporting agencies and direct investigation.

PERSONAL GUARANTEE
In consideration of credit being extended by ROPPEL INDUSTRIES, INC. to the above named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each jointly and severally hereby contract and guarantee to ROPPEL INDUSTRIES, INC., the faithful payment, when due, of all accounts of said applicant for purchases. The undersigned guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant presentment and demand payment with respect to any security held by ROPPEL INDUSTRIES, INC., extension of time of payment to applicant, acceptance of partial payment, or partial compromise, all other notices to which the undersigned guarantors might otherwise be entitled and demand for payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to ROPPEL INDUSTRIES, INC., before said revocation becomes effective.

I accept the above terms.

Please Sign Below

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Submit the Request

By clicking 'Submit', I/We authorize Roppel Industries or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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