Credit Application

Thank you for your interest in our business. We strive to fulfill all of your laundry equipment needs. In orer that we may establish an open line of credit for your company, please furnish the following requested information. Our terms are due upon receipt. A valid Credit Card is required as a backup payment method.*

Business Legal Name:(Required)

Bill to Address:(Required)

Street Address Address Line 2 City State ZIP Code

DBA:(Required)

Ship to Address:(Required)

Street Address Address Line 2 City State ZIP Code

Management Company(Required)

Main Phone number:(Required)

Fax number:(Required)

Ownership:(Required)

Corporation

Partnership

Proprietorship

LLC

Name of President, Owner or Partner:(Required)

State of Incorporation:(Required)

Year(Required)

FED ID#:(Required)

Social Security Number:(Required)

Date Business Opened(Required)

Date of new Ownership(Required)

Taxable?(Required)

Yes

If no, please provide a copy of Tax Exempt Resale Certificate or other form of proof. We must have this on file or sales tax will be billed on all orders.

Are purchse orders required?(Required)

Yes

Authorized Purchaser:(Required)

Person to contact regarding accounts payable:(Required)

Name

Phone/Fax(Required)

Accounting Email:(Required)

Bank Reference:

Bank Name:(Required)

Account Number:(Required)

Address(Required)

Street Address City State ZIP Code

Contact Person:(Required)

Phone number:(Required)

Fax number:(Required)

Business / Trade References

Name:(Required)

Contact:(Required)

Address:(Required)

Street Address City State ZIP Code

Phone:(Required)

Fax:(Required)

Account #:(Required)

Name:(Required)

Contact:(Required)

Address:(Required)

Street Address City State ZIP Code

Phone:(Required)

Fax:(Required)

Account #:(Required)

Name:(Required)

Contact:(Required)

Address:(Required)

Street Address City State ZIP Code

Phone:(Required)

Fax:(Required)

Account #:(Required)

Agreement, Release & Signatures

*Credit Card on file will be used to process payment for any invoice that exceeds 30 days. Should credit be extended to us, I understand and agree that the terms we are allowed are effective from the DATE OF INVOICE. I also hereby agree, on behalf of my company, that any and all interest charges resulting from late payment will be paid. Interest charges may be billed if an invoice reaches 30 days past due. I hereby certify that the above information is true and that you may obtain and investigate any infromation you deem necessary for the evaluation of my company’s credit status.

Signed:(Required)

Print:(Required)

Title:(Required)

Date(Required)

Personal Guarantee

In consideration of Southeastern Laundry Equipment (“The Company”) extending credit to the above named Applicant, I hereby personally guarantee to (“The Company”) payment of all obligations of the Applicant and I hereby agree to bind myself to pay (“The Company”) on demand any sum which may become due by the Applicant whenever the Applicant shall fail to pay the same. It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of Applicant. I do hereby waive notice of default, non-payment and notice thereof and consent of any modification or renewal of the credit agreement hereby guaranteed, and to all renewals of extension of credit. The undersigned guarantor agrees to pay, in the event the amount becomes delinquent and is turned over to collection, collection fees equal to 20% of the balance due plus all attorney fees/court costs/interest charges.

Signed:(Required)

Print:(Required)

Date(Required)

NEW ACCOUNT CREDIT CARD AUTHORIZATION FORM

COMPANY NAME(Required)

NAME AS IT APPEARS ON CREDIT CARD(Required)

BILLING ADDRESS(Required)

ZIP CODE(Required)

CARDHOLDER'S PHONE NUMBER(Required)

CARDHOLDER'S RELATIONSHIP TO COMPANY(Required)

CREDIT CARD NUMBER(Required)

CREDIT CARD EXPIRATION DATE (MM/YY)(Required)

CARD TYPE (MC/VS/AMEX/DISC)(Required)

CCV(Required)

EMAIL FOR CC RECEIPT(Required)

You have provided us with your credit card information, and you hereby authorize us to charge such credit card for any future amounts owed pursuant to this agreement which you have not timely paid.

Signature(Required)

Today's date(Required)

Industries Served

Leasing

Industrial (OPL)

Find Your Local Sales Rep

Revenue Share

Multi-Family Housing

Find Your Local Sales Rep

Laundromat

Industries Served

Leasing

Industrial (OPL)

Find Your Local Sales Rep

Revenue Share

Multi-Family Housing

Find Your Local Sales Rep

Laundromat

Credit Application