Credit Application

+1 630.293.4000 info@floorscrapers.com

Onsite Equipment Manufacturing will accept a digital signature on the below documents. Should you need to print and sign, please scan the documents and email them to us at info@floorscrapers.com.

Printable – Credit Application

We will notify you in due course of the outcome of your application.

Company Information
I/we consent to data being stored according to the guidelines set out in the Privacy Policy.

Company Name:

Company Address:

City:

State:

Zip:

Telephone No.:

Sole owner

Social Security No.:

S Corporation

Social Security No.:

Incorporated

State:

Partnership

Please list owners:

Year Established:

Banking Information

Bank Name:

Bank Telephone No.:

Bank Address:

City:

State:

Zip:

Type of Account:

Account Number:

I hereby authorize Onsite Equipment Manufacturing to whom this application is made to, make their customary credit inquiry on the above listed trade and bank references and release and information desired by Onsite Equipment Manufacturing. The undersigned agrees that all credit extended shall be deemed subject to the terms of Net 30.

Full Name:

Title

Date:

Telephone No.:

Email:

Trade References
Reference #1

Name:

Telephone No.:

Address:

City:

State:

Zip:

Reference #2

Name:

Telephone No.:

Address:

City:

State:

Zip:

Reference #3

Name:

Telephone No.:

Address:

City:

State:

Zip:

I certify that (Company Name)

is engaged as a registered

[radio* terms-reg-radio-781 use_label_element default:1 “Wholesaler” “Retailer” “Mfg” “Lessor” “Contractor”]

and is registered with the below listed states and cities within which your firm would receive purchases and that any such purchases are for the wholesale, resale, leased, or rented in the normal course of our business.

City or State:

State Registration or I.D. No.:

City or State:

State Registration or I.D. No.:

City or State:

State Registration or I.D. No.:

Certify that if any property so purchased tax free is used or consumed as to make it subject to a Sales or Use Tax, will pay the tax due direct to the proper tax authority when state law provides or inform for added tax billing. This certificate shall be part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until cancelled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Release of Credit and Bank Information
I (We) have applied for open credit terms with Onsite Equipment Manufacturing and hereby release any information they may require. The undersigned agrees that all credit extended shall be deemed subject to the terms of Net 30. In addition, my signature below signifies my approval for my bank and creditors to respond to any credit inquiries regarding my application. I confirm that all information submitted is correct and as well as acceptance of all mentioned terms and conditions.
Authorized Signature (Owner, Partner or Corporate Officer)

Your Full Name:

Your Title:

Company Name:

Date of Release