281-933-1100
281-933-1159 Fax
888-933-0100 Toll Free
email: info@filtera.com
Proud Member of:
Prices and specifications are subject to change without notice. All sales are made subject to the terms and conditions contained in the Filtera, Statement of Business Policy , as revised from time to time, a current copy of which is available at this website.
Copyright © 2003-2006 Filtera
All rights reserved.
This Commercial Credit Application is for the convenience of repeat business purchasers that desire to open a credit account with Filtera. Please download the PDF version, or print this page, complete & fax to (281) 933-1159
Our credit application processing often takes a couple of weeks. The actual amount of time required depends on how long it takes for your references to reply to our credit verification requests. In the meantime, if you need to order, we accept most major credit cards.
APPLICANT |
Company Name |
Address (number, suite, street) |
Address (city, state, zip) |
Mail Address (number, suite,
street) |
Mail Address (city, state, zip) |
Primary Business Activity |
Date Business Established |
Organizational type
(corporation, partnership, etc.) |
Federal Tax ID Number |
DUNS Number (Dunn & Bradstreet) |
Approximate Annual Sales (in
U.S. dollars) |
APPLICANT CONTACT PERSON |
Contact Person & Title |
Name of Principal & Title |
Contact Phone (area code & number) |
Contact Fax (area code & number) |
Contact Email |
BANK REFERENCE |
Bank Name |
Bank Contact Person Name & Title |
Address (number, suite, street) |
Address (city, state, zip) |
Contact Phone (area code & number) |
Contact Fax (area code & number) |
Contact Email |
Account Number 1 & Type |
Account Number 2 & Type |
COMMERCIAL CREDIT REFERENCES (please
include supplier references only) |
Company Name (Supplier Reference No. 1) |
Address (number, suite, street) |
Address (city, state, zip) |
Credit Terms |
Contact Person |
Contact Phone (area code & number) |
Contact Fax (area code & number) |
Company Name (Supplier Reference No. 2) |
Address (number, suite, street) |
Address (city, state, zip) |
Credit Terms |
Contact Person |
Contact Phone (area code & number) |
Contact Fax (area code & number) |
Company Name (Supplier Reference No. 3) |
Address (number, suite, street) |
Address (city, state, zip) |
Credit Terms |
Contact Person |
Contact Phone (area code & number) |
Contact Fax (area code & number) |
|
AGREEMENT This application is
for the purpose of obtaining COMMERCIAL CREDIT and is warranted
by Applicant to be true, correct, and complete in all respects.
Filtera (Company) is hereby
authorized to investigate the references listed, and obtain additional
credit information from third parties (including but not limited to
credit reporting agencies). Applicant
has received and agrees to the terms and conditions detailed in the Filtera
Statement of
Business Policy. Company
may amend this Statement of Business Policy from time to time, with a
current version provided to applicant upon request. Upon credit
approval, Applicant agrees to payment terms of NET 30 DAYS.
Any past due invoice is subject to a charge of 1 ½% per month
(18% annual rate), plus all costs of collection, including but not
limited to attorney fees if collection becomes necessary.
Invoices 15 days past due will result in orders being placed on
hold pending account payment to a current basis.
Applicant warrants that Applicant is not currently under the
jurisdiction of a bankruptcy court.
Applicant agrees to immediately notify Company in writing
should Applicant initiate bankruptcy proceedings, or have any
significant change in business operations or ownership. The below named signatory represents that he/she is an owner, or officer of Applicant, and that he/she is duly authorized by Applicant to bind Applicant to the terms of this Agreement. In the event that Applicant defaults on this Agreement, the signatory to this Agreement represents and warrants that he/she will be personally responsible and liable for immediate payment in full, upon demand, of all amounts due including any interest charges and costs of collection. |
Authorized Signature (for Applicant) |
Printed Name of Signatory |
Title of Signatory |
Date |