AGRA TURF, INC.
PO Box 9168 Searcy, AR 72145 -(501)268-7036, FAX (501)268-0606
APPLICATION FOR CREDIT
General Information:
Please Check One:_____Individual ______Partnership ________Corporation
Type of Business________________________Years in Business_____ _____
Sales Tax:
Tax Rate:________Tax Exempt#(attach a copy)________________________
Billing Address:
Name:_________________________________________________________
Address:_______________________________________________________
City:_______________State:____________Zip Code:___________________
County:_____________Telephone:_______________Fax:________________
EMAIL:________________________________________________________
Accounts Payable Manager:_________________________________________
Shipping Address:
Business Name:__________________________________________________
Street Address:___________________________________________________
City:___________________State:____________________Zip Code:________
County:_______________Telephone:_______________Fax:_______________
Superintendent:___________________________________________________
Restricted Use Pesticide License Information: (attach a copy)
Licensee Name:___________________________________________________
License Number:____________________________Exp. Date______________
If Corporation:
Corporation Number:_____________________________________________
State of Incorporation:_______________ID Number____________________
Principal Shareholder:____________________________________________
Name of Owners or Officers:
Name:__________________________Address:________________________
Name:__________________________Address:________________________
Bank Reference:
Bank Name:______________________________Contact Name:___________
Address:________________________________________________________
City:_______________________________State:___________Zip Code:_____
Trade References:
Name:____________________________________Account#______________
Address:________________________________________________________
City:____________________________State:___________Zip Code:________
Phone Number:_______________________Fax:________________________
Name:____________________________________Account#______________
Address:________________________________________________________
City:_____________________________State:__________Zip Code:________
Phone Number:_______________________Fax:________________________
Name:__________________________________Account #_________________
Address:__________________________________________________________
City:_____________________________State:_____________Zip Code:_______
Phone Number:_______________________Fax:__________________________
By signature I certify to the best of my knowledge, the accuracy of the information provided herein and agree to notify AGRA TURF, INC. of any changes in this information.
I understand that AGRA TURF, INC. retains title to the merchandise until fully paid for.
I further understand that payment is due 30 days from the date of our invoice and that failure to pay on time may result in the suspension of credit.
Buyer shall pay all costs, charges and expenses including court and reasonable attorneys fees incurred to recover delinquent charges.
AUTHORIZED SIGNATURE:__________________________________TITLE:__________________
Individual Personal Guaranty
I,_____________________________________________residing at___________________________________________________________________
for and in consideration of extending credit at my request to_______________________________________
(hereafter referred to as the “Company”) of which I am _______________________ hereby guarantee to AGRA TURF, INC., payment of any obligation to the company
and I hereby bind myself to pay you on demand any sum which may become due to you by the company, whenever the company shall fail to pay same.
It is understood that this guarantee shall be a continuing and irrevocable guarantee and indemnity for such indebtedness of the company.
I do hereby waive notice of default, non-payment and notice thereof and consent to any modifications or renewal of the credit agreement hereby guaranteed.
Signature:_______________________________________________