Credit Application

Credit Application Login Account (optional)

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CREDIT REQUESTER INFORMATION

Date * +

Requestor's Name *

Requestor's Email *

Requestor's Phone Number *

Credit Amount Requesting *

Requested for: *

BUSINESS INFORMATION

Business Name *

Billing Address *

Billing City *

State *

Zip Code *

Business Phone Number *

A/P Contact Name *

A/P Email Address *

Business Type *

Business Industry *

Year Business Established *

Owner/Officer Information

	Name	Title
Officer 1	Name	Title
Officer 2	Name	Title
Officer 2	Name	Title

TRADE REFERENCES

Trade Reference #1 Business Name *

Trade Reference #1 Contact Name *

Trade Reference #1 Phone Number *

Trade Reference #1 Fax Number *

Trade Reference #1 Email *

Business Type *

Years Doing Business *

Trade Reference #2 Business Name *

Trade Reference #2 Contact Name *

Trade Reference #2 Phone Number *

Trade Reference #2 Fax Number *

Trade Reference #2 Email *

Business Type *

Years Doing Business *

Trade Reference #3 Business Name *

Trade Reference #3 Contact Name *

Trade Reference #3 Phone Number *

Trade Reference #3 Fax Number *

Trade Reference #3 Email *

Business Type *

Years Doing Business *

BANK REFERENCE

Bank Name *

Bank City *

Bank State *

Bank Contact Person *

Bank Contact Email *

Bank Contact Phone *

Checking Account Number *

Savings Account Number

I hereby authorize the release of information to Brimar Industries for the purpose of establishing an open credit account * 🛈

clear

TERMS OF SALE

NET 30 DAYS-Service Charge: 1 ½% per month (18% per annum) assessed to undisputed invoice unpaid 60 days from invoice date.

BEFORE USING, USER SHALL DETERMINE THE SUITABILITY OF THE PRODUCT FOR HIS/HER INTENDED USE AND ASSUME ALL RISK AND LIABILITY WHATSOEVER IN CONNECTION WITH THE USE.

NO RETURNS WILL BE ACCEPTED WITHOUT WRITTEN AUTHORIZATION. ALL CLAIMS MUST BE MADE IN WRITING NO LATER THAN 30 DAYS AFTER RECEIPT OF MERCHANDISE OR FORFEITURE OF CLAIM WILL RESULT.

ON DEFECTIVE MATERIAL, OUR LIABILITY IS LIMITED TO THE VALUE OF THE MATERIAL OR REPLACEMENT OF SAME. NO ALLOWANCE WILL BE MADE FOR LABOR OR MATERIAL USED IN THE ASSEMBLY.

ANY SUGGESTIONS MADE BY SELLER CONCERNING USES OR APPLICATIONS OF SAID MATERIALS REFLECT SELLER'S OPINION ONLY AND SELLER MAKES NO WARRANTY OF RESULTS TO BE OBTAINED.

LIMITATION OF LIABILITY. WITHIN FIFTEEN (15) DAYS AFTER RECEIPT SHIPMENT OF MATERIAL SOLD HEREUNDER,

BUYER SHALL EXAMINE SUCH MATERIAL FOR ANY DAMAGE, DEFECTS OR SHORTAGE. ALL CLAIMS, INCLUDING CLAIMS

FOR ALLEGED OR DEFECTIVE GOODS, SHORTAGE OR NON-DELIVERANCE OF GOODS, NEGLIGENCE OR ANY OTHER CAUSE WHATSOEVER, SHALL BE DEEMED WAIVED UNLESS MADE IN WRITING AND RECEIVED BY SELLER WITHIN THIRTY (30) DAYS AFTER BUYER'S RECEIPT OF THE MATERIAL. FAILURE OF BUYER TO GIVE NOTICE OF ANY CLAIM WITHIN SUCH TIME PERIOD SHALL BE DEEMED AN ABSOLUTE AND UNCONDITIONAL WAIVER OF SUCH CLAIM, REGARDLESS OF WHETHER PROCESSING, USE OR RESALE OF THE MATERIAL SHALL HAVE TAKEN PLACE. BUYER'S EXCLUSIVE REMEDY SHALL BE FOR DAMAGES AND SELLER'S LIABILITY FOR ANY AND ALL LOSSES OR DAMAGES RESULTING FROM ANY CAUSE WHATSOEVER, INCLUDING ALLEGED NEGLIGENCE, SHALL IN NO EVENT EXCEED THE PURCHASE PRICE OF THE MATERIAL IN RESPECT TO WHICH THE CLAIM IS MADE, OR AT THE ELECTION OF THE SELLER, THE REPAIR OR REPLACEMENT OF SUCH MATERIAL. SELLER SHALL NOT BE LIABLE FOR, AND BUYER ASSUMES RESPONSIBILITY FOR, ALL PERSONAL INJURY AND PROPERTY DAMAGE RESULTING FROM HANDLING, POSSESSION, USE OR RELEASE OF THE MATERIAL. IN NO EVENT SHALL SELLER BE LIABLE FOR SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES. WHETHER BUYER'S CLAIM IS IN CONTRACT, NEGLIGENCE, STRICT LIABILITY OR OTHERWISE. TRANSPORTATION CHARGES FOR THE RETURN OF MATERIAL SHALL NOT BE PAID UNLESS AUTHORIZED IN ADVANCE BY SELLER.

I agree to Brimar Industries Terms of Sale (Initials) *

Agreement Date * +

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