Credit Application Company Information Legal Business Name * DBA * Federal Tax ID Number * Physical Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Phone * (###) ### #### Accounts Payable Contact Name * First Name Last Name Telephone Number * (###) ### #### Fax Number * (###) ### #### Email * Company Owner / Authorized Signer / Guarantor Principal or Officer Name * First Name Last Name Title * Telephone Number * (###) ### #### Years in Business * DUNS Number * Business Structure * LLC Corp Other Requested Credit Amount * $ Requested Payment Terms * 5 Days 10 Days 15 Days 21 Days Method of Payment * EFT ACH COD CC Credit Terms and Conditions The undersigned Applicant hereby authorizes VITA COMPANY USA, to contact the credit and trade references disclosed on this Credit Application, as well as bureau and/or credit reporting agencies to obtain from such entities information that we deem necessary to enable us to evaluate this Credit Application. In addition, Applicant hereby authorizes the references disclosed herein to release to us all information requested pertaining to applicant's account, business practices and credit history. Applicant initially agrees that the following terms and provisions shall apply to purchases VITA COMPANY USA If the TOTAL INVOICE PRICE is not paid in full on or before the due date, a late charge of 1.14% per month on the past due amounts computed from the due date of each invoice shall be due and owing. * A $35.00 handling fee will be charged to the Applicant for each returned payment, which will be due and payable by the Applicant. * In the event it becomes necessary for us to employ legal counsel to enforce any of the provisions of the Agreement, or the breach thereof, then, in that event, Applicant will pay all costs incurred, including without limitation, attorney fees and collection costs. * This agreement shall be governed by and construed under the laws of the State of California. By execution of this Agreement, Applicant hereby consents to the jurisdiction and venue of the Superior Court of California, in the county of Los Angeles, and agrees this Agreement may be enforced through such court or, if appropriate, an alternative dispute organizationlocated in Los Angeles, California. * Applicant represents and warrants that it has the authority to enter into the Agreement and that the person executing this Agreement has been duly authorized to do so for and on behalf of the Applicant. Applicant further represents and warrants under penalty of perjury that the information furnished by the Applicant is true and correct. Signature * Date * MM DD YYYY Thank you!
