Sales Tax Status:
Exempt (Attach exemption Certificate)
Add New Row
"THE UNDERSIGNED CERTIFIES TO FAIRMONT SUPPLY COMPANY AND ITS AFFILIATES INCLUDING, WITHOUT LIMITATION, PIPING AND EQUIPMENT, INC. (COLLECTIVELY, "FSC") FOR AND ON BEHALF OF APPLICANT* THAT THE INFORMATION PROVIDED IN THIS CREDIT APPLICATION AND AGREEMENT IS ACCURATE AND COMPLETE, (ii) THAT THE UNDERSIGNED IS DULY AUTHORIZED TO EXECUTE AND DELIVER THIS CREDIT APPLICATION AND AGREEMENT ON BEHALF OF APPLICANT, (iii) THAT APPLICANT IS APPLYING FOR CREDIT FOR A BUSINESS PURPOSE, AND NOT FOR PERSONAL, FAMILY OR HOUSEHOLD PURPOSES, AND (iv) THAT APPLICANT HEREBY AGREES TO BE BOUND BY THIS CREDIT AGREEMENT. APPLICANT ACKNOWLEDGES AND AGREES THAT FSC'S PAYMENT TERMS ARE NET THIRTY (30) DAYS, AND IF APPLICANT'S VALID TAX EXEMPTION CERTIFICATE IS NOT ATTACHED, APPLICABLE STATE AND LOCAL TAXES WILL BE CHARGED. THE UNDERSIGNED, FOR HIMSELF OR HERSELF AND ON BEHALF OF APPLICANT, HEREBY AUTHORIZES FSC OR ANY LENDER OR FUNDING SOURCE WHICH MAY BE UTILIZED (COLLECTIVELY, THE "LENDERS") (a) TO OBTAIN A CREDIT REPORT (CONSUMER OR OTHERWISE) WITH RESPECT TO THE APPLICANT THAT WILL BE ONGOING AND RELATES NOT ONLY TO THE EVALUATION AND/OR EXTENSION OF BUSINESS CREDIT REQUESTED, BUT ALSO FOR PURPOSES OF REVIEWING THE ACCOUNT, INCREASING THE CREDIT LINE ON THE ACCOUNT (IF APPLICABLE), TAKING COLLECTION ACTION ON THE ACCOUNT, AND FOR ANY OTHER LEGITIMATE PURPOSE ASSOCIATED WITH THE ACCOUNT AS MAY BE NEEDED FROM TIME TO TIME, AND (b) TO CONTACT ANY OF THE REFERENCES LISTED ABOVE IN CONNECTION WITH THEIR INVESTIGATION OF APPLICANT'S CREDIT WORTHINESS. APPLICANT FURTHER AUTHORIZES THE ABOVE CREDIT REFERENCES TO RELEASE INFORMATION ABOUT APPLICANT'S BUSINESS RELATIONSHIPS WITH THEM TO FSC AND THE LENDERS AT ANY TIME. THE UNDERSIGNED ACKNOWLEDGES THAT FSC MAY REPORT THE PAYMENT HISTORY OF APPLICANT TO CREDIT REPORTING AGENCIES. APPLICANT (AND NOT THE UNDERSIGNED INDIVIDUALLY) AGREES TO REIMBURSE FSC FOR ALL COSTS ASSOCIATED WITH COLLECTING PAST DUE BALANCES, INCLUDING BUT NOT LIMITED TO ATTORNEY FEES, WHETHER SUIT BE BROUGHT OR NOT. APPLICANT EXPRESSLY AGREES THAT REGARDLESS OF PLACE OF PAYMENT, THE TERMS OF THIS AGREEMENT SHALL BE GOVERNED BY THE LAWS OF PENNSYLVANIA, WITHOUT REGARD TO ITS CONFLICT OF LAW PROVISIONS, AND THE PARTIES AGREE TO SUBMIT TO THE EXCLUSIVE JURISDICTION OF PENNSYLVANIA. THE UNDERSIGNED WARRANTS THAT THE ABOVE AGREEMENT HAS BEEN CAREFULLY READ AND THE APPLICANT UNDERSTANDS AND AGREES TO THE SAME.
*Applicant is defined as the company listed above under General Business Information, and not the individual completing this application for Applicant."
ECOA NOTICE (TO BE RETAINED BY APPLICANT)
Thank you for your business credit application. If your application for business credit is denied, you have the right to a written statement on the specific reasons for your denial. To obtain that statement, please contact us within 60 days from the date that you are notified of our decision. We will send you a written statement of the reasons for the denial within 30 days of your request for the statement. NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that administers our compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.