Company Information:
*Full Legal Company Name
Owner Name
*Company Type — Corporation Partnership Proprietorship
*Address
*City
*State
*Zip
*Phone
Fax
*Years in Business
*Number of Employees
D&B Number
*Federal Tax ID or Social Security Number
*Description of Business
*Requested Credit Limit
Bank Information
Bank Name
Bank Account Number
Bank Contact Name
Bank Contact Number
First Trade Reference
Company
Contact
Contact Phone
Account Number
Second Trade Reference
Third Trade Reference
Supporting Documentation
Please upload any supporting documents such as your standard credit application
Authorization
Release of Authority to Verify (While every effort will be made to determine credit worthiness based on information provided, it may become necessary to request financial statements). Permission is herewith granted to obtain credit information from all listed references, including the bank. All financial information submitted in support of this account and credit application is true and complete in all respects.
In consideration for credit being extended, purchaser acknowledges and agrees to the following: (1) Payment is guaranteed to Triad Telecom, Inc. within 15 days from the date of invoice; (2) any charges unpaid after the above 15 days are to be increased by 2% per month; (3) any charges still outstanding after 45 days from date of invoice are subject to collection, and all collection or arbitration expenses, attorneys’ fees, and court costs will be borne by the purchaser; (4) all claims, request for adjustments, or notification of errors must be made within ten days from invoice date, or charges are considered accepted; (5) any omission or misrepresentation of material fact in this application may result in refusal of or termination of credit; (6) credit privileges may be withdrawn at any time without invalidating the terms of this agreement; (7) Triad Telecom, Inc. is authorized to make reference checks and purchaser hereby waive any right to see the references obtained. Purchaser hereby release the references from any liability concerning the information released by them to Triad Telecom, Inc.; (8) Triad Telecom, Inc. may provide information about purchaser to others about its credit experience with each purchaser; (9) this Agreement shall be governed by and under the laws of the State of North Carolina; (10) a waiver of breach of any of the terms and conditions hereof shall not be considered to be a modification of any provision nor shall such waiver act to bar the enforcement of any subsequent breach; (11) this Agreement supersedes and cancels all prior oral and written agreements between the parties with respect to this subject matter; (12) this Agreement may not be changed in any way except by an instrument in writing executed by an executive officer of Triad Telecom, Inc.; (13) no representation of Triad Telecom, Inc., which are not stated herein, shall be binding on Triad Telecom, Inc.; (14) no course of dealing or course of performance shall be relevant to explain or supplement any term expressed in this Agreement; (15) everything stated in the application for credit is correct and Purchaser acknowledges that Triad Telecom, Inc. has relied on representations made by Purchaser in this application; (16) that no pending law suit or judgment against Purchaser exists; (17) this Agreement shall apply to all current and future charges and constitutes the entire agreement between the parties pertaining to the subject matter of this Agreement.
*Authorized Signature (enter first and last name)
*Authorized Title — President / CEO Vice President Treasurer / CFO Owner Partner
*Authorized Email Address
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