Credit Application Form

Company Information:

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Principal Owners, Officers and Partners:

Bank Reference:

Credit Reference:

Company Reference 1

Company Reference 2

Company Reference 3

Acknowledgement:

Applicant certifies that the information set forth above is accurate and may be relied upon in making credit decisions within Automann’s sole discretion. Applicant authorizes Automann or its agents to obtain credit reports for purposes of this application and to obtain further credit information from any source including any person listed in this application. Applicant authorizes any bank with whom the applicant is doing business with to give all necessary information to Automann or its agents in connection with this credit inquiry. All monthly accounts are due within 30 days of invoice. Any unpaid balances will be assessed a 1.5% monthly penalty. In consideration of Automann extending credit, we the undersigned, as authorized representatives, stockholders, directors and/or principals, jointly and severally guarantee the payment of any and all future obligations to Automann on behalf of the applicant. In the event of default on this account, applicant agrees to pay all costs of collections, including but not limited to attorney’s fees, court cost and collection agency fees.

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