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Credit Application
Credit Application
For the purpose of obtaining merchandise from MESA FASTENER, INC. (seller), the following statement is made by the Applicant, intended that Mesa Fastener should rely on same as correct.
Business Name
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Billing Address
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City
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State
*
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New Jersey
New Mexico
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North Dakota
Ohio
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Rhode Island
South Carolina
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Tennessee
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Utah
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Washington
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Wisconsin
Wyoming
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Zip Code
*
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Shipping Address
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City
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State
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Alaska
Arizona
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California
Colorado
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Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip Code
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Telephone Number
*
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Fax Number
*
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Nature of Business
*
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Type of Business
*
Sole Proprietorship
Partnership
Corporation
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Years in Business
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Number of Employees
1-5
6-10
10-20
20-50
50+
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FEIN or SSN
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Are your purchases subject to Sales Tax?
*
Yes
No
n/a
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If NOT subject to sales tax, please provide resale number
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Credit Amount Requested $
*
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Accounts Payable Contact
*
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Title
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Accounts Payable Telephone Number
*
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Accounts Payable Email
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List all Owners, Officers, or General Partners (if possible, please include title and DL # with State Issued)
*
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TRADE REFERENCE 1 (list only active vendors, no credit cards)
Company
*
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Contact
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Adress
*
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City
*
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State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Telephone
*
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Fax
*
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TRADE REFERENCE 2
Company
*
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Contact
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Address
*
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City
*
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State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Telephone
*
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Fax
*
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TRADE REFERENCE 3
Company
*
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Contact
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Address
*
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City
*
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State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Telephone
*
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Fax
*
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Please provide necessary bank information
Bank Name
*
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Person to Contact
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Address
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City
*
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State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Zip Code
*
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Telephone
*
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Fax
*
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TERMS OF AGREEMENT AND APPLICATION FOR CREDIT
In consideration of Mesa Fasteners extension of credit to Applicant, Application agrees to pay under the terms of this Agreement and Application for Credit (the “Agreement”) when due (a) all debts, liabilities and obligations, now existing or hereafter coming into existence; (b) a service charge not to exceed 1 ½% per month, or 18% per annum, (or the maximum allowable contract rate under applicable law) on the unpaid balance of any account or other Obligations (the “Service Charge”); (c) a 3% service charge will be added to balances paid by credit card; (d) we do offer a 2% -10 days term discount for early payments by check; and (e) reasonable attorneys’ fees, costs and expenses incurred in connection with the collection and enforcement, or any attempts at collection and enforcement, of such debts, liabilities or obligations of Applicant, by or through any attorney, all of (a), (b) and (c) shall be referred to as the “Obligations”. Venue for collections will be San Diego County. Applicant agrees to pay for all goods purchased within 30 days of the date of the invoice. If Applicant falls to comply with Mesa Fasteners prevailing terms of any of the provisions of this Agreement, Mesa Fastener may declare the unpaid balance on this account immediately due and payable. In this event, Applicant agrees to pay such balance upon demand or Mesa Fastener may, in the manner and as provided by applicable law, retake the goods or pursue any further remedy provided by applicable law.
Applicant hereby authorizes the use of this document, or a facsimile, thereof, as consent for the release of credit information to Mesa Fastener by the attached listed Trade and Bank References.
If more than one person shall execute this Agreement, the term “undersigned” shall mean all parties executing this Agreement, and any liability under this Agreement shall be joint and several.
By clicking on "I, the "undersigned" accept and agree to the terms stated above" below", I consent that the statements on this Agreement are true, correct and complete, and that they have been made in order to obtain credit from Mesa Fastener, Inc. I also consent that I am authorized to release the information provided and request credit, on behalf of the company that this contract is pertaining to. By selecting the button below, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement.
*
I, the "undersigned" accept and agree to the terms stated above
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Print Full Name (electronic signature)
*
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Title
*
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How should we contact you?
*
Phone
Fax
Email
Mail
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Your e-mail address for follow-up
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*
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Home
About Us
Our Team
Products
Blind Rivets
Bolts & Cap Screws
Drywall Screws
Machine Screws
Masonry Anchors
Non-Ferrous
Nuts
Self-Drilling Screws
Socket Products
Tapping Screws
Thread Cutting Screws
Tools
Washers
Woodworking Screws
Resources
Guide to Fastener Sizes
Credit Application
Employment Application
Request a Quote
Request a Quote