5640 Gravois
 St. Louis, MO 63116
 (314) 351-1751
 (800) 572-4728  FAX (314)351-2148                           HOME PAGE

Credit Application                                                        

PLEASE COMPLETE THE FOLLOWING FORM AND CLICK 'SUBMIT' AT THE BOTTOM OF THE PAGE.
Or, you may print this page and fax your signed copy to Gary LaDuke at the fax number above.

Date:

Company Name
Bill To Address
Ship To Address
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-MAIL

Is Your Business:    Individually Owned Partnership Corporation

Name(s) of Owner(s) and Title(s):

Name

Title
Name Title
Name Title

Kind of Business:        Years in Business   

County:        Tax Exempt (if yes, enclose a tax exempt form):    Yes No

Accounts Payable Contact:

Name
Title

P.O. Required:    Yes No

Approximate Credit Line Desired:

$1,000-$5,000
$5,000-$10,000
$10,000-$20,000
Over $20,000 (financial statement required)

TRADE REFERENCES WITH WHOM YOU HAVE ESTABLISHED CREDIT

Trade Reference 1:

Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone

Trade Reference 2:

Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone

Trade Reference 3:

Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
 

BANK INFORMATION

Name Of Bank 
Address
Account Number
Line of Credit Number
Phone Number
Fax Number
Contact Person

Permission For Bank To Release Information:



Type Signature

Name of Company

Name of Persons Authorized to Charge on Account:

    As a duly authorized owner/officer of the previously stated corporation, I/we, the undersigned, warrant that the information herein given is correct and request that standard credit terms be extended to our company based on this information.  I/we authorize HESS MEAT MACHINES to verify our credit background and further authorize our references to release information directly to HESS MEAT MACHINES for such verification.
    The following TERMS OF SALE are agreed to:  Terms are net 30 days with a monthly service charge of 1/5% assessed and due 30 days after billing date.  Purchases, which are delinquent, will result in the account being placed on COD or CIA status.  Authorization must be made for all returned merchandise at which time it will be subject to a 15% handling charge.  A returned check will result in a return check fee of $20.00 and the account being placed on COD or CIA: certified funds or cash only until the returned check(s) is/are cleared.  Your credit line may be revoked or otherwise changed if returned checks are experienced.
    Monthly statements are mailed for reconciliation purposes only.  If the account is not paid in full as agreed, applicant agrees to pay all costs and expenses of collection, including costs and expenses on appeal, if any.  These expenses shall include a reasonable attorney fee.  If the outstanding balance is equal to any amount less than $5000.00 the undersigned agrees that the attorney's fee shall be a liquidated sum of 20% of the outstanding balance.  Thereof, we herein wave all rights relating to venue and agree that any and all legal actions shall be brought in the county of St. Louis, State of Missouri.

(Owner or Corporate officer must sign.)


Type Signature



Title



Date

______________________________________________________________________________________

 

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