| APPLICATION FOR CREDIT Submit to 614-873-9275 Or E-mail to: gordon.kibler@invensys.com |
 CLIMATE CONTROLS Maplechase Uni-Line Ranco Robertshaw |
| Firm Name ___________________________________________________________________________ |
| dba ___________________________________________________________________________ |
| Box or Street __________________________________________________________________________ |
| City _________________ State/Province _____________________ Zip/Postal _________________ |
| Phone _______________ Fax _______________ E-Mail ____________________________________ |
| Accounts Payable Contact ______________________________________ Phone _________________ |
| E-Mail _______________________________________________________ Fax __________________ |
| Street _______________________________________________________________________________ |
| City _______________ State/Province ______________________ Zip/Postal _________________ |
| D&B # _______________________ Tax ID # ______________________ Years in Business ________ |
| Sales Tax Certificate Number(s) ___________________________________________________________ |
| Operates as a: __ Proprietorship __ Partnership __ Corporation __ LLP |
| If a Proprietorship, Partnership or LLP, list below the name(s) of the owner(s) |
| Name ___________________________________________________________________ |
| Name ___________________________________________________________________ |
| Has any of the owners or the company ever filed for bankruptcy? __ Yes __ No |
| Has a judgement ever been granted against the company? __ Yes __ No |
| Expected purchases $ ___________ per year. |
| REFERENCES |
| NAME LOCATION (Street, City, State or Province) PHONE FAX |
| 1. ____________________________________________________________________________________ |
| 2. ____________________________________________________________________________________ |
| 3. ____________________________________________________________________________________ |
| 4. ____________________________________________________________________________________ |
| Bank Name ___________________________________________ Account # __________________ |
| Street Address _________________________________________ Account # __________________ |
| City _____________________ State/Province ________________________ Zip _________________ |
| Loan Officer or contact _________________________________________________________________ |
| Phone _____________ Fax _____________ E-Mail ______________________________________ |
| By signing below I/we agree: |
| * That all information funished above is accurate. |
| *
To allow all aforementioned trade and bank references to supply
credit information for the purpose of establishing or maintaining a credit account. |
| *
That the extension of credit may be rescinded or altered by
Invensys's credit department at any time from order acceptance, during the manufacturing period or at any time product is ready for shipment. |
| *
To pay interest charges at the rate of 1.5% per month or the maximum
amount allowed by statute on any amount not paid within the terms as indicated on each invoice. |
| * To pay each invoice within the terms as indicated on each invoice. |
| * That until credit has been established it may be necessary to prepay for shipments. |
| * That financial statements may be required to assess our company's credit worthiness. |
| Signature ________________________________________________ Date ___________________ |
| Print Name ___________________________________________________________________________ |
| Officer or Owner Title |