Please fill out the credit application below and someone from our finance team will be in touch. 1Business info2Bank / Trade Info3Terms and Conditions Business Information / Company BackgroundBusiness Name / Other Trade Names: ("Customer")Federal Tax ID:Entity Tax Status (Pick One):Sole ProprietorPartnershipCorporationLimited Liability CompanyBilling Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Shipping Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Contact First Last TitlePhoneFax #Email Enter Email Confirm Email Year EstablishedYears at Current AddressNature of BusinessWebsite Owner InformationEnter the three owners with the greatest ownership percentage in that order. If the entity is owned by another entity please enter the entity owner and attach a sheet with the owners, addresses, phone numbers and SSN’s and ownership percent of such entity.Owner #1 - Name First Last Owner #1 - AddressOwner #1 - PhoneOwner #1 - SSN or EINOwner #1 - Ownership %Owner #2 - Name First Last Owner #2 - AddressOwner #2 - PhoneOwner #2 - SSN or EINOwner #2 - Ownership %Owner #3 - Name First Last Owner #3 - AddressOwner #3 - PhoneOwner #3 - SSN or EINOwner #3 - Ownership % Bank / Loan InformationPlease provide the following information about any bank accounts, notes, mortgages, etc., and attach a sheet for additional institutions: Institution #1 NameInstitution #1 AddressInstitution #1 PhoneInstitution #1 Type of AccountInstitution #1 Account No.Institution #2 NameInstitution #2 AddressInstitution #2 PhoneInstitution #2 Type of AccountInstitution #2 Account No.Trade ReferencesPlease provide two trade references which the business has had open for one year or more. If none, enter the most long term relationship.Trade Reference #1 - Business NameTrade Reference #1 - Primary ContactTrade Reference #2 - AddressTrade Reference #1 - PhoneTrade Reference #2 - Length of RelationshipTrade Reference #2 - Business NameTrade Reference #2 - Primary ContactTrade Reference #1 - AddressTrade Reference #2 - PhoneTrade Reference #1 - Length of RelationshipMiscellaneousHas the business or any of the owners been in, or anticipate being in bankruptcy or insolvency?NoYesPlease upload sheet related to the bankruptcy or insolvency.Max. file size: 512 MB.Does the business, any of its assets, or its owners have a UCC filing against them?NoYesPlease upload sheet related to UCC filing.Max. file size: 512 MB.Does the business lease any real property, vehicles, major equipment, or any other substantial items?NoYesPlease attach a sheet describing the item(s), lessor, the contact information of the lessor, the estimated annual lease payment, and lease length.Max. file size: 512 MB.Is there any other information we should know about the businesses pertinent to this application?NoYesPlease attach any additional information.Max. file size: 512 MB. Terms and ConditionsTerms are Net if paid within thirty (30) days. If an account is past due, Hopkins shall have the right to require cash on delivery. Customer agrees to pay to Hopkins a service charges in the amount of two (2%) percent per month on any past due account balances. In the event Hopkins places the account for collection, Customer agrees to pay all of Hopkins’ costs of collection and collection fees, including, but not limited to, attorney’s fees in the amount of twenty-five (25%) percent of the outstanding indebtedness and court costs.Agreement with TermsCustomer hereby applies to E. Frank Hopkins Co., Inc. (“Hopkins”) for Credit, and should Credit be granted, the Customer acknowledges to have read and understand and agrees to be bound by Hopkins’ E. Frank Hopkins Co., Inc. Terms and Conditions of Sale, and any future amendments as herein incorporated by reference. I agree to the E. Frank Hopkins Co., Inc. Terms and Conditions of SaleThird-Party Authorization THIS WILL SERVE AS AUTHORIZATION TO ANY THIRD PARTY TO RELEASE INFORMATION TO HOPKINS FOR THE PURPOSE OF DETERMINING CUSTOMER’S CREDIT STANDING AND FINANCIAL RESPONSIBILITY.Certification WE CERTIFY THAT ALL THE INFORMATION ON THIS APPLICATION/CREDIT AGREEMENT IS CORRECT; AND THAT WE FULLY UNDERSTAND AND ACCEPT HOPKINS’ TERMS AND CONDITIONS OF SALE WHICH IS ATTACHED HERETO.Authorization to Release Personal Account Information The undersigned individual who is either the applicant or a principal of the applicant, recognizing that his/her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by Hopkins, from time to time as may be needed, in the credit evaluation process.Guarantee IN CONSIDERATION OF THE FINANCIAL ACCOMMODATIONS MADE TO CUSTOMER, THE UNDERSIGNED, JOINTLY AND SEVERALLY, HEREBY ABSOLUTELY, UNCONDITIONALLY, AND IRREVOCABLY PERSONALLY GUARANTEE PAYMENT OF ANY AND ALL SUMS WHICH MAY BE PRESENTLY DUE AND OWING AND OF ALL SUMS WHICH SHALL IN THE FUTURE BECOME DUE AND OWING TO HOPKINS FROM THE CUSTOMER. IT IS UNDERSTOOD THAT THIS GUARANTEE IS CONTINUING AND IRREVOCABLE.Electronic SignatureELECTRONIC SIGNATURE ACKNOWLEDGEMENT I agree and understand that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement and the Terms and Conditions referred to herein.Business Name:Individual Electronically Signing Form:Title of Signor:Date of Signature MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
