Credit Application

    D&G Electrical Supply Co., Inc.
    62 Railroad Ave W. Garnerville. NY 10923
    Phone (845)947-2626, Phone (888)249-7097,Fax (845)947-2971
    www.dandgelectricalsupply.com

    Credit Application (please write or type legibly)

    Date:

    Business Name:

    Address:

    City, State & Zip Code:

    Business Phone & Fax:

    Business Bank & Branch:

    Business Checking Account Number:

    Business Bank & Branch:

    Business Checking Account Number:

    Business Reference:

    Name:

    Address:

    Phone:

    Fax:

    Contact:

    Business Reference:

    Name:

    Address:

    Phone:

    Fax:

    Contact:

    Business Reference:

    Name:

    Address:

    Phone:

    Fax:

    Contact:

    Type of Business:

    The applicant hereby applies for a credit account t o do business with D&G Electrical Supply Co., Inc. (hereinafter “D&G”). The undersigned applicant and guarantor swear, unde r penalties of perjury that the information supplie d on page (1) one of this document is correct and t rue.

    The undersigned applicant does hereby agree to the following terms and conditions concerning a credit account:

    a) the applicant agrees to pay for any and all materials ordered from D&G , either through the app licant's company, employees or other entities of th e applicant.
    b) the applicant agrees to pay all invoices fro m D&G within the term of 30 days of the invoice dat e from D&G.
    c) a surcharge of 11/2 percent will be assessed monthly on all invoices not paid in accordance wit h sub-paragraph (b) above; 30 days.
    d) if invoices are not paid within the provisio ns of sub-paragraph (b) above, the applicant and th e guarantor agree to pay all Court costs, disbursem ents and all billable legal fees concerning collect ion efforts and judgment enforcements; and
    e) the guarantor undersigned states that he/she is an officer of the above mentioned business enti ty and as such guarantees that any and all material s ordered from D&G, either through applicant's comp any, employees or other entities of the applicant is his /her sole responsibility and the guarantor will hon or and pay all invoices billable to his/her busines s.

    Business Entity

    Signature By Guarantor

    Print Guarantor's Name