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South Park Corporation

Use this form to apply for credit with South Park Corporation, or you can
download the PDF Version. Then print it, fill it out, and fax it to us.

Name of Business (dba):
Type of Business: Sole
Partnerhsip
Corporation
Corporation or other name:
Date Business Started:
Street Address:
City:
State:
Zip:
Billing Address:
City:
State:
Zip:
Business Telephone:
Fax Number:
Accounts Payable Phone:
Name of Accounts Payable Contact:
Owner of Location : (other than business)
Bank Name and Branch:
Contact:
Business Check Acct. No.:

Please state the nature of your business:

Name and home address of officers, partners, owners, or other responsible parties
Full Name Title Res. Address Telephone
1:
2:
3:

List three principal suppliers with whom you have maintained credit for a minimum of one year.
Full Name Fax Number
1:
2:
3:

For Corporations only - General Continuing Guarantee
Name Address City/State/Zip Phone
The above listed hereby jointly severally and personally guarantee the prompt payment of any and all indebtedness of the applicant to the seller according to the terms thereof. In case suit of action is instituted to collect any portion of an account owed by any parties to this agreement, I/we promise to pay such additional sums as the court may adjudge reasonable, including any attorney's fee.

Please read before submitting:
For the purpose of establishing credit with creditor, I/we warrant this financial information to be true, correct and complete to the best of my knowledge. By submitting this form, I hereby authorize any credit investigation needed for verification. I also hereby agree to the terms, net 30 days unless otherwise stated. In event of collection, customer pays all costs and attorney fees. Any balance over 30 days is subject to a service charge of 1-1/2% per month (18% per annum).
Your Name: Your Title:
Your Email:  required Date:
 
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