Credit Application

D&G Electrical Supply Co., Inc.
62 Railroad Ave W. Garnerville. NY 10923
Phone (845)947-2626, Phone (888)249-7097,Fax (845)947-2971
www.dandgelectricalsupply.com
Credit Application (please write or type legibly)
Date:
Business Name:
Address:
City, State & Zip Code:
Business Phone & Fax:
Business Bank & Branch:
Business Checking Account Number:
Business Bank & Branch:
Business Checking Account Number:
Business Reference:
Name:
Address:
Phone:
Fax:
Contact:

Business Reference:
Name:
Address:
Phone:
Fax:
Contact:

Business Reference:
Name:
Address:
Phone:
Fax:
Contact:

Type of Business:
The applicant hereby applies for a credit account t o do business with D&G Electrical Supply Co., Inc. (hereinafter “D&G”). The undersigned applicant and guarantor swear, unde r penalties of perjury that the information supplie d on page (1) one of this document is correct and t rue.

The undersigned applicant does hereby agree to the following terms and conditions concerning a credit account:

a) the applicant agrees to pay for any and all materials ordered from D&G , either through the app licant's company, employees or other entities of th e applicant.
b) the applicant agrees to pay all invoices fro m D&G within the term of 30 days of the invoice dat e from D&G.
c) a surcharge of 11/2 percent will be assessed monthly on all invoices not paid in accordance wit h sub-paragraph (b) above; 30 days.
d) if invoices are not paid within the provisio ns of sub-paragraph (b) above, the applicant and th e guarantor agree to pay all Court costs, disbursem ents and all billable legal fees concerning collect ion efforts and judgment enforcements; and
e) the guarantor undersigned states that he/she is an officer of the above mentioned business enti ty and as such guarantees that any and all material s ordered from D&G, either through applicant's comp any, employees or other entities of the applicant is his /her sole responsibility and the guarantor will hon or and pay all invoices billable to his/her busines s.

Business Entity
Signature By Guarantor
Print Guarantor's Name