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Application for Business Credit

Please fill out the form below to apply for credit with Heartland Florist Supply, Inc. This is just an application and does not automatically grant the applicant the credit and or the amount that the applicant requests. For more information about credit, please contact our billing department and ask for Jennifer. (918)-543-4711

 

Business Information
Business Name:
Sales Rep:
Amount of credit needed:
Business address:
Business Phone:
Business fax:
Business city:
Business state: 
Business zip: 
Owner information
Owner Name:
Owner address:
Owner Phone:
Owner fax:
Owner city:
Owner state: 
Owner zip: 

References
Name 1:
Phone 1:
Name 2:
Phone 2:
Name 3:
Phone 3:

Financial Institution
Bank Name:
Phone:

> Terms and Conditions

*Please note, applicants form will be processed, however; before credit will be issued, this form must be printed and applicants true signature must be applied to the formal document. This quick form only allows us to speed up the process by providing the Applicant with either, a declined or awarded credit status. Applicants signature below constitutes consent and agreement to the following terms and conditions.

, warrants that all statements on this form are true and correct and are made for the purposes of obtaining credit information from Heartland Florist Supply, Inc. Applicant  authorizes Heartland Florist Supply, Inc. to request credit information from the references herein listed or from other sources pertaining to Applicants financial responcibility. Applicant agrees to make payment within 30 days of the billing date on Heartland Florist Supply, Inc. invoices. Applicant further agrees to pay late payment penalty of 1.5% per month (18% annually) on any unpaid balance due. If applicant utilizes an agency, Applicant and Agency shall be jointly and severely liable for the payment of all the supplies provided to the Applicant.

Name:   Title:   Date:

*Please note, as stated above, agreeing to this statement only allows Heartland Florist Supply, Inc. the ability to process this form for credit. Before credit is issued, a formal handwritten signature must be written on the form you will receive via US mail.

 

> Personal Guaranty

In order to induce Heartland Florist Supply, Inc. to extend credit to the applicant for payment for floral supplies purchased by Applicant or its authorized Agency and all liabilities of Applicant hereunder, the undersigned ("Guarantor") hereby fully and unconditionally guarantees the prompt payment of any sums owed to Heartland Florist Supply, Inc. for such services. Guarantor waives all rules of law whatsoever legally permitted to be waived which would, if not waived, impair the enforcement impair the enforcement of release hereof. Guarantor further agrees to pay late payment penalty of 1.5% per month (18% annually) on any balance due. Guarantor agrees to indemnify Heartland Florist Supply, Inc. for all expenses incurred in connection with the collection of amounts payable, including court costs and attorney's fees.

Guarantor:    Date:

Address:       Phone: