CREDIT APPLICATION (Wholesale)

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Oriental Garden Supply, LLC
448 W. Bloomfield Rd.
Pittsford, New York 14534
Phone: 585-586-3850
Fax: 585-586-8945
Email: orientalgardens@aol.com

Print form

Please fill out the information in this form, save a copy for yourself, and mail, email, or bring it to us at the address listed above.

All information supplied will be held in the strictest confidence and used solely for the purpose of determining your credit line.

Company Name
Address
Telephone
Fax

Check One:	Proprietorship Partnership LLC Corporation
State Incorporated In
How Long in Business?
Type of Business

List Officers, Partners, or Owners:
Name	Title	Home Address

Bank Reference:
Name of Institution	Branch
Address	Phone
Bank Contact	Type of Account
Account #

Business Credit References:
Name (company & business)	Full Address	Phone

Does your company require purchase orders? Yes No

Authorized Purchasers:

The applicant is hereby advised that our terms are 30 days net. Past due accounts will be assessed a service charge of 1 ½% per month. All claims must be reported within 10 days of receipt of goods and submitted in writing lest all consideration be waived. This agreement is construed under the laws of the State of New York with venue in Monroe County. In the event it becomes necessary to file suit to enforce payment we shall be entitled to court costs, attorney’s fees, and interest at 1 ½% per month of amounts due and payable. Corporate officers hereby acknowledge and assume personal responsibility for debts incurred in the name of the firm.

I have read, understand and accept the above terms, have provided true information to the best of my knowledge and have retained a copy of this agreement for my records.

Authorized Signature:		Date:


Print Name:		Title: