Page 479 - Merrick Tackle Catalog
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MERRICK TACKLE
479
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POLICY PAGES
PART II
Please complete the following if you would like to pay C.O.D. (company or personal check) or open terms.
The following three
business creditors
currently grant your company the highest line of credit or accept
C.O.D. checks. Please, no banks, credit unions, friends, family, utility companies or charge card companies.
Company:
____________________________
____________________________
Phone Number:
____________________________
Fax Number (important):
____________________________
Company:
____________________________
____________________________
Phone Number:
____________________________
Fax Number (important):
____________________________
Company:
____________________________
____________________________
Phone Number:
____________________________
Fax Number (important):
____________________________
PART III
CHARGE CARD PAYMENTS:
Please see policy pages concerning discounts. Signature of card holder is held on file as authorization.
Check one: VISA
MASTERCARD
DISCOVER
AMERICAN EXPRESS
Charge Card No
:______________________________________
Expiration date: ________ CID#_____________
Issuing Bank____________________________
Name as shown on card (please print)_____________________________
Signature of card holder
:_____________________________________________________
Signature gives Merrick Tackle authorization to charge my current card for any invoices not paid within account terms.
Billing Address
:__________________________________________________________________
Please notify us in writing if you ever wish to change any of the above.
Estimated current worth of the firm: _________________. I/We warrant that the firm is solvent.I/We warrant that no owner
(if a partnership or proprietorship) and no officer (if a corporation) has been the subject of a personal bankruptcy in the last
ten years and that the firm is not currently in any bankruptcy.It is agreed that a service charge of 1 1/2% per month may be
charged on all delinquencies or the highest rate permitted by prevailing state law, whichever is lower.
Permission is hereby granted to discuss our account with the creditors listed above. It is understood that company policy of
the supplier requires that an update of this application will be provided upon request every 12 months by the applicant
firm.
___________________________________________
(Name of Applicant Firm)
___________________________________________ _____________________ _________________
(Signature of authorized agent)
(Title)
(Date)
I warrant that the foregoing information is true and correct and realize it will be relied upon in the granting of future credit.
_________________________________, Individually
(Signature)
