Contact

First *

Last *

Phone *

Email *

Company/Store

Company Name *

Website Address

Enter N/A if you don't have a website.

Type of Store/Business *

If selected other, explain what type of Busineess

Registered Company Address:

Address 1 *

Address 2

City *

State *

Postal code/Zip *

Country *

Form ID

Date Business Commenced

Credit Line Requested

Applicant

Principal/Partner/Officer Full name *

Home Address *

Address 2

City *

State *

Postal code/Zip *

Country *

How long at current address?

Phone - Home/Cell

Bank information

Bank Name *

Bank Phone

Bank Address *

Address 2

City *

State *

Postal code/Zip *

Country *

Type of Account

Account Number

BUSINESS/TRADE REFERENCES

Reference-Company Name 1 *

Email *

Phone *

Reference-Company Name 2

Phone

Reference-Company Name 3

Phone

Reference-Company Name 4

Phone

Once we receive your credit application, our accounting department will review it and notify you of the decision.

Agreement

1. All invoices are to be paid 30

days from the date of the invoice.

2. Claims arising from invoices must be made within 10 business days.

3. All overdue invoices bear interest at 1.5% per month per annum (or maximum allowed by law) on unpaid balance. There is also a $40 returned payment fee for any declined cheques/automatic withdrawals.

4. In the event of default of payment when due, all costs of collection, including attorney’s fees and court costs, shall be paid by the applicant.

5. Any credit extended to the applicant may be reduced or eliminated in the event NACH, in its reasonable discretion, determines that the applicant’s financial situation or ability to pay is impaired.

6. By submitting this application, you authorize NACH to make inquiries into the banking and business/trade references that you have supplied.

I agree *

By submitting this application, I am authorizing a Credit Review and release of banking and/or financial information. I also acknowledge that terms of payment are Credit Card or Prepaid until net terms are approved. Each invoice will be subject to a 1.5% charge per month if not paid according to approved account terms. Should applicant default in payment, NACH shall be entitled to additional incurred collection costs and attorney’s fees to the unpaid balance.

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Country/region

Collection: Esschert’s Countrywear

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