Credit

Business Information

Registered Legal Name of Business *

DBA

Application Type * Select OneChargeCash

Serving Store * Select OneBarreBellows FallsBerlinBiddefordBrattleboroBurlingtonClaremontConcord (S Main St)Concord (Old Turnpike Rd)DerbyDerryDoverEliotExeterFranklinGreenfieldHillsboroJaffreyKeeneKennebunkLaconiaLancasterLincolnLondonderryLyndonvilleManchesterMeredithMiddleburyMilfordMontpelierNashuaNewportNorthfieldPittsfieldPlymouthRandolphRaymondRutlandSalemSalisburySanfordSomersworthSpringfieldSt. JohnsburyWeareWest Lebanon

Phone Number *

Mobile Number

Fax Number

Billing Information

Billing Address *

Billing City *

Billing State * Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Billing Zip Code *

Shipping Information

Same as Billing AddressEnter New Address

Additional Information

Estimated Monthly Purchase Volume *

Date Business Established *

Business Type * Select OneSole ProprietorPartnershipCorporationLLCMunicipality

Purchase Order Required * Select OneYesNo

Statement Delivery * Select OneMailEmail

Account Type * Select OneGarageDealershipFleetGovernmentBody ShopOther

Tax Exempt * Select OneYesNo

Business Contacts

Accounts Payable Primary Contact *

Email Address *

Phone Number *

Owner's Name *

Owner's SSN/EIN *

Owner's Address *

City *

State * Select OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Other Contact Name

Title

Email Address

Phone

Trade Reference One Name

Email Address

Phone

Trade Reference Two Name

Email Address

Phone

Terms are net 24th. A monthly service charge of 1.5% (18% per annum) will be levied on all amounts 30 days past due from the due date, including accrued and unpaid interest. I agree to pay my account in full each month. I agree to pay Sanel NAPA all expenses Sanel NAPA incurs in connection with its extension of credit to me, including Sanel NAPA's reasonable attorney's fees. If any legal action is required to collect any sums due Sanel NAPA from the applicant(s) or guarantor(s) if a lawsuit is filed, I agree that interest will accrue at all times at the interest rate set forth above and not the statutory rate until payment is made in full. I hereby authorize any bank, financial institution or other company listed above and any credit reporting agency to release any information requested by Sanel NAPA in their credit investigation process. This authorization shall continue so long as any amounts owed are due and unpaid, specifically permitting Sanel NAPA to receive credit information about the applicant or guarantor at any time to aid in consideration of continuing or extending credit or in collecting any sums due.
I agree that this account is unrestricted unless I notify Sanel NAPA in writing to the contrary requiring the use of purchase orders. I further understand that any restriction on this account can be honored at one location, to which the account has been assigned. I agree to be liable for the full balance due on this account, even if it exceeds the amount of credit requested. All terms of this application shall be governed by New Hampshire law. Any proceeding relating to this application or to sales made by Sanel NAPA to the applicant shall be brought only in a court of competent jurisdiction in New Hampshire. I agree that all purchases made pursuant to this application shall be for business purposes only, and shall not be used or deemed sales made for personal, family, or household purposes. This application may be assigned by Sanel NAPA to any person or entity, and the applicants' and guarantors' obligations hereunder shall remain binding.