Instructions:
Print this page
Fill out the requested information and mail to:
Bauer Radiator, Inc
3805 Walden Ave.
Lancaster, NY 14086


Taken by______________________________________________

Date__________________________________________________
 

Please print or Type

("Applicant)
COMPANY  NAME______________________________________

Street Address__________________________________________

City___________________________________________________

State_____________________Zip___________________________
 

 

Mailing Address

Street Address__________________________________________

City___________________________________________________

State_____________________Zip___________________________
 

 

Phones:
Main           (            )   _________________________________

Accounting   (           )  _________________________________

Other          (            ) __________________________________
 

 

Owner(s) Officers _________________________________________

________________________________________________________

______________ __________________________________________

 

TYPE OF OWNERSHIP

Corporation Partnership Individual  LLC          

 


____________________________________________
* BANK (where business is conducted)

Mailing Address

Street Address__________________________________________

City___________________________________________________

State______________________Zip__________________________

Account#(s)_____________________________________________
 

*By signing this credit application, Applicant authorizes the above-named bank to release credit information on a strictly confidential basis to Bauer Radiator Inc.

BUSINESS REFERENCES (Where credit is now extended)

#1

Name___________________________________________________

Address_________________________________________________

City____________________________________________________

State_________________ Zip___________________

Phone (          )________________________________

FAX # (          )________________________________

Account#_____________________________________
 

Applications with less than 4 business references will not be considered

#2

Name___________________________________________________

Address_________________________________________________

City____________________________________________________

State_________________ Zip___________________

Phone (          )________________________________

FAX # (          )________________________________

Account#_____________________________________

 

#3

Name___________________________________________________

Address_________________________________________________

City____________________________________________________

State_________________ Zip___________________

Phone (          )________________________________

FAX # (          )________________________________

Account#_____________________________________

 

#4

Name___________________________________________________

Address_________________________________________________

City____________________________________________________

State_________________ Zip___________________

Phone (          )________________________________

FAX # (          )________________________________

Account#_____________________________________

 

Please indicate credit line you wish extended

$_______________________
 

 

PAYMENT AGREEMENT & GUARANTEE OF PAYMENT

Please Read the Following Agreement Statement Carefully!

By signing this Credit Application and Payment Agreement, Applicant represents that the information contained herein is accurate in all respects.  Applicant further represents that (s) he has the full corporate authority to execute this Agreement.

Applicant authorizes, Bauer Radiator Inc., hereinafter to as " the company" or its agents(s), to investigate any credit and financial information, including banking records, as the Company in its sole discretion deems necessary.  As part of that opening, monitoring, renewal and extension of this and other accounts with the Company. Applicant further authorizes the Company to share information received from credit reports with the Company's subsidiaries, affiliates, and its agent(s).

Applicant acknowledges and agrees to pay for all merchandise purchased on credit account from the Company within Thirty (30) DAYS of statement date. ANY INVOICE OR PORTION THEREFORE NOT PAID WHEN DUE SHALL BE SUBJEDT TO INTEREST OR SERVICE CHARGES OF 2.0% PER MONTH (APR = 24% PER ANNUM ) ON ANY OUTSTANDING BALANCE SHOWN ON THE STATEMENT.

A 1% discount is allowed on payments received by the 10th of the month following purchase, unless special arrangements are made at the time of purchase. Postmarks are used as a basis for receipt of payment.  Therefore, it is imperative to allow for delivery time. Applicant understands that should the account be more than thirty (30) days past due, credit may be suspended and Applicant may be sold to on a "COD" basis only, thereafter,.  Future credit may be reinstated at the sole discretion of the Company. Applicant further agrees to pay any and all expenses, including collection and reasonable attorney's fees, costs and disbursements that are incurred by the Company, should it become necessary to refer Applicant's credit for collection.

SIGNATURE OF APPLICANT ( OFFICER)

____________________________________________________

____________________________________________________
(Print Name and Title)
 Date_____________________________


GUARANTEE OF PAYMENT

In consideration of and in order for the Company to extend credit to the Applicant, Guarantor personally and absolutely guarantees full and prompt payment when due. By signing this Guarantee of Payment, Guarantor acknowledges that Guarantor guarantees the debts and obligations of the Corporation and is obligated to perform all of the terms contained in this Application.  Guarantor further agrees to pay any and all expenses, including collection and reasonable attorney's fees, costs and disbursements that are incurred by the Company, should it become necessary to refer Applicant's credit for collection.

If Guarantor is other than a person, reference to " personal " or " individual" herein shall refer to it in its entity capacity.

SIGNATURE OF INDIVIDUAL PERSONALLY GUARANTEEING ("GUARNTOR" )

____________________________________________

____________________________________________
(Print Name)
 Date_____________________________


SECURITY AGREEMENT ( IF APPLICABLE)

 If this box is checked, Applicant must sign Company's Security Agreement granting company a Purchase Money First Security Interest in any and all merchandise purchased by Applicant from company under this or any other credit arrangement by and between Applicant and Company. Applicant must, at all times any obligation is owed to Company.

SIGNATURE OF APPLICANT ( OFFICER)

_________________________________________________

_________________________________________________
(Print Name and Title)
 Date_____________________________

Please return completed form to :
BAUER RADIATOR INC
3805 Walden Ave.
Lancaster NY 14086

Phone: Local: 716-681-9777
Nationwide: 800-GO-BAUER
Fax: 716-685-1863