Credit Application & Sales Agreement

Type of business *

Owner/officer Information

Have you ever declared bankruptcy? *

Trade References

Bank Reference

As an officer for the above named company, I hereby give my consent to check any agencies or companies necessary in processing this application. I certify that the above information is correct and promise to pay for all purchases in accordance with the terms and conditions of sales. I further agree to pay for all collection costs incurred by Westermeyer Industries Inc. if made necessary by failure to comply with the payment terms and conditions of sales.