A. THOMAS FOOD
SERVICE
(502)253-2000 FAX: (502)253-2020
CREDIT APPLICATION
LOCAL BUSINESS NAME: ________________________________________________________________________________
LOCAL
BUSINESS ADDRESS: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
LOCAL
CONTACTS 1. ______________________________________________________________________
PRINTED
NAME TITLE PHONE
2.
______________________________________________________________________
PRINTED NAME TITLE PHONE
TYPE
OF ORGANIZATION: (CHECK ONE) ___CORPORATION ___PARTNERSHIP ___SOLE PROPRIETORSHIP
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CORPORATE
NAME: ______________________________________________________________________
CORPORATE
BUSINESS ADDRESS: ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
CORPORATE
CONTACTS 1. ______________________________________________________________________
PRINTED
NAME TITLE PHONE
2. ______________________________________________________________________
PRINTED NAME TITLE PHONE
*********************************************************************************************************
PARTNERSHIP/SOLE
PROPRIETORSHIP:
PRINCIPAL ADDRESS PHONE %OWN
1. ___________________________ _________________________________________ ____________ _________
_________________________________________
2. ___________________________ _________________________________________ ____________ _________
_________________________________________
NUMBER
OF YEARS OF CURRENT BUSINESS OPERATION:
________________
TRADE CREDIT REFERENCES:
NAME ADDRESS PHONE
NAME ADDRESS PHONE
NAME ADDRESS PHONE
BANK REFERENCE:
_____________________________________________________________________________________
NAME
_______________________________________________________________________________________
ADDRESS
_______________________________________________________________________________________
PHONE CONTACT
CREDIT APPLICATION
PAGE
2
NAMES AND
SOCIAL SECURITY NUMBERS OF INDIVIDUALS SIGNING CHECKS:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
RETAIL EXEPTION CERTIFICATE NUMBER:
_____________________________________________________________
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The above supplied information is true and complete. Upon signing below, A. Thomas Food Service is
authorized to check credit history or financial information as it relates to
the establishment of a trade relationship with the applicant.
______________________________________________________________________________________________________
AUTHORIZED OFFICER TITLE DATE
INDIVIDUAL PERSONAL GUARANTEE
In consideration
of the extension of credit to __________________________________________
(Debtor)
________________________________________________________________
(Guarantors), jointly and severally guarantee to A. Thomas Food Service
(Creditor), the prompt payment of all accounts due Creditor, and if past due
pay the finance charge as per the legend on each invoice (currently 1.5% per
month). The undersigned guarantor agrees
to pay, in the event the amount becomes delinquent and is turned over to an
attorney for collection, reasonable attorney fees plus all collection costs. This Guarantee shall continue until such time
as the creditor shall receive notice of revocation by registered mail. Such notice of revocation shall be
ineffective as to any existing indebtedness.
GUARANTOR: ________________________________________
GUARANTOR: ________________________________________
WITNESS: ________________________________________
DATE: ________________________________________