Unique Products for the 21 st Century! To all Mega Hertz Clients,
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1 To all Mega Hertz Clients, The following is our application for credit procedures & documents. Please have the appropriate person complete the application and have it signed by an officer or owner of the company. In order to expedite our approval process, please ensure the following information on the credit application is completed. 1. Credit Limit Desired (Page 1, below Trade Reference 3) 2. extension of credit will not be more than $ (Page 2) 3. Application must be signed by an officer of your company 4. The Affidavit of Tax Compliance completed in full 5. Bank reference & three (3) industry trade references with whom you have credit limits equal to or higher than the credit you are requesting Return the completed original documents by mail to: Mega Hertz 4100 International Plaza, Suite 150 Ft. Worth, TX Att: Credit Manager To expedite the process, please fax all documents to (817) and we will begin processing your application immediately. Thank you for choosing Mega Hertz, we look forward to serving you.
2 MHz CREDIT APPLICATION AND AGREEMENT (Page 1) Applicant Name: (Legal Name) Corporation: Public Private Address: Partnership: Address: EIN#: City/State:_ Website address: Zip Code: Phone# (Area Code): FAX # (Area Code): If, Sole Proprietor or Partnership Owner (s) Name: Owner (s) Name: Home Address: Home Address: Home Phone: Home Phone: SSN: SSN: TRADE REFERENCE 1: TRADE REFERENCE 2: (Company) _ (Company)_ (Address) (Address) (Contact) (Contact) (Account #)_ (Account #)_ (Telephone)_ (Telephone) TRADE REFERENCE 3: (Company)_ (Address) (Contact) (Account #)_ (Telephone) BANK REFERENCE: (Name) (Address) (Contact) Checking ACCT# Savings ACCT# (Telephone) Persons authorized to make purchases for Applicant and their address (Name) address (Name) address (Name) address Credit Limit Desired $
3 MHz CREDIT APPLICATION AND AGREEMENT (Page 2) The undersigned (Applicant) hereby applies for a business credit account with Mega Hertz. The credit is not for personal, house hold or family use. The Applicant will abi de by the term s as charged or as set out on any contract, purchase order, invoice, bill of lading or any ot her documents, all of whi ch are made a part he reof, for any go ods, equipment and services delivered by Mega Hertz at the costs of goods, equipment or services and payment will be due in full within thirty (30) d ays of delivery of goods, equipment or services by Mega He rtz unless otherwise agreed to in writing. By this d ocument ( The "Agreement") Mega Hertz is entitled to obtain credit information from the reference listed above. In all purchases, under the account created by this application, as de scribed in the Applicant s Purchase order and/or MHz shipping documents, the Applicant grants to Mega Hertz a security interest, until such time as the Applicant fullfills its obligation to MHz for payment of all goods, equipment and/or merchandise purchased and delivered by MHz. The Signatory here to warrants that he or she and the person(s) listed above have the authority to obligate the Applicant by purchasing goods, equipment and services from Mega Hertz, and that he or she has the authority to bind the company to this Agreement. The Applicant shall be responsible for payment of all sales and use taxes and shall indemnify and hold harmless Mega Hertz from any loss, cost, or expense Mega Hertz may incur, including attorney fees and court costs, in the event the Applicant fails to pay such taxes. The Signatory acknowledges that this Agreement is being prepared for the purpose of receiving goods, equipment or services on credit from Mega Hertz and that the anticipated extension of credit will not be more than $. The Signatory warrants that he or she has personal knowledge of the financial condition of the Applicant and represents that the Applicant is in good financial condition, will be able to pay Mega Hert z in the amount of the credit limit, and will so pay within thirty (30) days of d elivery of the g oods, equipment or services. In the event of a breach of this agreement, including bankruptcy, assignment for the benefit of creditors or nonpayment, Mega Hertz shall be entitled to recover all cost of collection, interest, principal and reasonable attorneys' fees. In the event of failure of timely payment Mega Hertz shall be entitled to receive interest on the past due amount at the annual rate of eighteen (18%) percent in addition to the principal balance. The place of performance and transaction of business shall be deemed to be in the County of Arapahoe, State of Colorado, and in the eve nt of litigation, the Applicant consents to in personam jurisdiction of the Colorado courts, County of Arapahoe, State of Colorado. Should any of the provisions of this A greement be deemed by a court of competent jurisdiction to be void, voidable or unenforceable, only that provision shall be affected thereby and all other provisions shall remain fully enforceable.
4 MHz CREDIT APPLICATION AND AGREEMENT (Page 3) MEGA HERTZ (Legal Name of Applicant) Accepted by (Signature) Printed Name of Signer Title Date Accepted by (Signature) (Must be an officer/owner of the company) Printed Name of Signer Title Date address All blanks, including signature, as well as, "AFFIDAVIT of TAX COMPLIANCE" below, must be completed before this application can be approved. Please include a copy of your most current financial statement. A signed copy will be returned to you upon credit approval and acceptance.
5 Attention: Financial Officer AFFIDAVIT OF TAX COMPLIANCE In order to comply with a pplicable tax issu es, plase have a financial officer or company owner complete this Affidavit of Tax Compliance indicating the status of your sales/use tax payments to the appropriate taxing authority in your area. Mega Hertz is only authorized to collect sales tax in the states of: AR, AZ,CA, CO, CT, FL, GA, IN, KS, KY, LA, MD, MO, NC, NY, NV, OH, OK, PA, TX, UT, VA, WA & WI. If you are located in one of the above States please provide: Name of County: City Name:_ Or If you are NOT located in one of the above States: I, _, will attest to the fa ct that our comp any will a ccrue and pay all applicable use tax on all purchases made from Mega Hertz Our Use Tax # for the State of is. Please attach a copy of your certificate for any of the States listed above. Or I,, will attest to the fact that our company is tax exempt. Our Tax Exempt # for the State of is. (Please provide a copy of your Tax Exempt Certificate along with this document.) (Applicant Name) Signature (Officer or Owner) Address Please print name City, State, Zip Title (Officer or Owner) Date address All documents must be completed in full and returned to Me ga Hertz via fax o r mail in order for your account to be opened or have any pending orders shipped. Thank you for your cooperation!
6 LETTER REQUESTING AUTHORIZATION TO RELEASE CREDIT INFORMATION Dear MHz Credit Applicant: Thank you for your recent interest in establishing credit with MHz. Please sign the authorization below for the release of credit information and we will begin contacting your Trade and Bank references. To whom it may concern: (Applicant Name) has recently applied for credit with MHz. I have been requested to provide and/or release information concerning the credit history of my Company. Therefore, I authorize the investigation of our Trade references and Bank information and hereby authorize the release of credit information This authorization is valid for thirty (30) days from the date of my signature below. Please keep a copy of my release request for your files. Thank you in advance for your cooperation. Person Authorizing release of information: Title of Person authorizing release of information: Signature: _ Date: address Company Address: Telephone #:
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