EZQuote | Credit Request

If you require any further information, feel free to contact our A/R specialist.

Jeneane Crooms

248-668-2107

Credit.Accounting@trekdirect.com

1 Company Information

Customer #:
Company Name:
Company Website:
Trade/DBA Name:
Address Line 1:
Address Line 2:

City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:

Headquarters Address:
Same as Above
Address Line 1:
Address Line 2:
City:
State/Province:

Zip/Postal Code:
Country:
Phone:

2 Company Identification

Federal Tax ID:

DUNS Number:

3 Shipping Preference

Location Preference:
Company Name Trade/DBA Name

Year Established:
(YYYY)
State/Province of
Incorporation:

Annual Sales:

Ownership
Owners or Partners:

#1:
Name:
Title:
Ownership:

Home Address:
Cell Phone:
Home Phone:

#2:
Name:
Title:
Ownership:

Home Address:
Cell Phone:
Home Phone:

#3:
Name:
Title:
Ownership:

Home Address:
Cell Phone:
Home Phone:

#4:
Name:
Title:
Ownership:

Home Address:
Cell Phone:
Home Phone:

#5:
Name:
Title:
Ownership:

Home Address:
Cell Phone:
Home Phone:

Title:
First Name:
Last Name:

Work Phone:
Email:

Account Payable (AP) Contact Info:
Name:
Phone:

Email:

Credit Amount Requested:
(USD)
Credit Terms:
Planned Monthly Purchase:
Type of Equipment:

Purchase Order Required?:
Yes No
Any Pending Order?:
Yes No
Pending Order Amount:
(USD)

Bank Name :
Address:
City:
State:
Zip Code:

Phone #:
Fax #:
Bank Acct #:
Contact Person:
Contact Email:

8 Trade Reference

- Please list at least three significant business relationships.

#1
Company Name :
Contact Name:
Address:

Phone #:
Fax #:
Email:

#2
Company Name :
Contact Name:
Address:

Phone #:
Fax #:
Email:

#3
Company Name :
Contact Name:
Address:

Phone #:
Fax #:
Email:

9 Tax Exempt or Resale Certificate

Located in US?:
Yes No

Resale/Other Tax Exempt?:
Yes No

Cert. Type :
Cert #:
State/Province:

Has Expiration Date? :
Yes No
Expiration Date:
Resale Certificate:
( Allowed file formats: .pdf, .docx, .doc, .jpg, .jpeg, .gif, .png etc) Invalid File format.

I hereby agree to be imposed of applicable taxes based on the store address proveded above #1.

10 Personal Guarantee

Guarantor's Print Name:

SSN :

Date:
04/23/2024

Personal Guarantee: This Personal Guarantee and the rights and obligations of the parties hereunder shall be governed by and interpreted, construed, and enforced in accordance with the laws of the State of Michigan, without reference to or effect being given to choice of law principles. Any proceeding arising out of or relating to this Personal Guarantee shall be brought in the courts of the State of Michigan, County of Oakland, or, if it has or can acquire jurisdiction, in the United States District Court for the Eastern District of Michigan. Guarantor, for itself and its successors and assigns, hereby agrees to and irrevocably (i) submits to the jurisdiction of the state and federal courts in the State of Michigan as identified herein, (ii) waives, to the fullest extent permitted by law, any objection that it may now or in the future have to the laying of venue of any proceeding arising out of or in connection with this Personal Guarantee brought in the state or federal courts in the State of Michigan as identified herein, (iii) waives any objection it may now or hereafter have as to the venue of any such action or proceeding brought in such court or that such court is an inconvenient forum, and (iv) agrees that any legal proceeding against any party to the Personal Guarantee arising out of or in connection with the Personal Guarantee shall be brought exclusively in the state or federal courts in the State of Michigan as identified herein. This provision may be filed with any court as written evidence of the knowing and voluntary irrevocable agreement between the parties to waive any objections to jurisdiction, to venue or to convenience of forum. Guarantor acknowledges that these waivers are a material inducement to Obligee’s agreement to enter into the Personal Guarantee.

We hereby apply for credit and affirm financial responsibility, ability and willingness to pay invoices in accordance with published terms. The above information is warranted to be true and complete. We hereby authorize you to verify and collect information on us, including but not limited to bank references, trade credit references, consumer and/or commercial credit reports. We agree to pay a monthly finance charge of 1.50% on all past due balances. We agree to pay all costs of collection and litigation on this account in accordance with the laws of the Creditor's State of Incorporation. We agree that all decisions with respect to the extension or continuation of credit shall be in the sole discretion of the Creditor.
We hereby also understand and agree, no additional credit will be extended to past due customer accounts unless satisfactory arrangements are made with our Credit Department. In the event it becomes necessary for Trek, Inc to either bring suit or employ a collection agency to aid in the recovery of any debt owed by the debtor, Trek, Inc shall be entitled to recover unpaid goods for debt owed.

Authorized Sign / Title:

Clear

Date:
04/23/2024

Credit Request Application

1 Company Information

2 Company Identification

3 Shipping Preference

4 Business Profile

5 Applicant's Info

6 Credit Request

7 Bank Reference

8 Trade Reference

9 Tax Exempt or Resale Certificate

10 Personal Guarantee

11 Authorized

Note: indicates Required Field.

Enter numeric value without comma in numeric fields. e.g. 1000.25