Gases
Hardgoods
ARC Gas & Supply Credit Application

To ARC Gas & Supply, LLC
We hereby apply for the extension of credit by your firm. The following information is submitted as a basis for your consideration of our application.

Legal Company Name
DBA
Division of
Business Type
Billing Address
Phone Number
Fax
Date Established
D&B Number
Type of Ownership
If Incorporated:
State in which registered
Federal ID#
Purchasing Agent
Accounts Payable Clerk
If Sole Proprietorship:
Name
Address
Home Phone
SS#
Phone
We expect our monthly credit requirements from you to be about $
We believe that our firm is financially able to meet any commitments we have made and we expect to pay our invoices according to your terms.
EXPECTED TERMS OF SALE
BANK REFERENCE
Bank Name
ACCT #
Address
City
State
Zip
Bank Location Phone
Contact
To Trade/Bank References for
Please be advised that you have our permission to release credit information to ARC Gas & Supply, LLC for the sole purpose of acquiring credit terms with the same. Please accept this signed release as my permission to you to release said information.


TRADE REFERENCES

Please list THREE references which allow you at least as much credit as you are requesting from us. In order to qualify as a reference, they should have sold to your company for at least ONE year on open terms, and your company should have purchased from them in the past six months.

Vendor Name
ACCT #
Street Address
City
State
Zip
Phone Number
Fax
Vendor Name
ACCT #
Street Address
City
State
Zip
Phone Number
Fax
Vendor Name
ACCT #
Street Address
City
State
Zip
Phone Number
Fax
Delinquent/Non-Payment of Account: In consideration for extension of credit to the undersigned, the undersigned shall be responsible for all costs of collections in the event the account becomes delinquent. These costs shall be included but is not limited to attorney's fees of 33 1/3% and any and all court costs associated with collection. The undersigned agrees to jurisdiction and venue in the Cuyahoga County Courts in the state of Ohio.
PERSONAL GUARANTEE: In consideration of credit being extended to the above named firm, I personally guarantee all indebtedness thereunder. I further agree that this guaranty is an absolute, complete and continuing one and no notice of the indebtedness of any extension of credit already or hereafter contracted by or extended need be given. The terms may be rearranged, extended and/or removed without notice to me.
BLANKET CERTIFICATE OF EXEMPTION
The undersigned hereby claims exemption to purchase of tangible personal property from ARC GAS & SUPPLY, LLC on and after

and certifies that this claim is based upon the purchasers proposed use of the items purchased, the activity of the purchaser, or both, as shown hereon:


PURCHASER MUST STATE STATUTORY REASON FOR CLAIMING EXEMPTION OR EXCEPTION

This certificate shall continue in force until revoked and shall be considered a part of each order given to the above named vendor unless the order specifies otherwise.

Purchaser's Name
Purchaser's Activity, i.e.
Manufacturer, Public
Utility, Church, etc.
Purchaser's Address
CorporationPartnershipLimited PartnershipProprietorship
Yes
accept
accept