Credit Application - Baucom's Nursery

Company Information
Company Name*
Date*
MM slash DD slash YYYY
Billing Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address*
Street Address Address Line 2 City State ZIP Code
Phone*
FAX*
Sales Tax #*
Please Attach Copy of Exemption Certificate
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB.
Type of Business*
- Foliage
- Landscape
- Farm
How long under present ownership?*
What is the form of business ownership?*

Principal Owners or Stockholders of Business
Please provide all applicable
Principal Owner or Stockholder 1*
First Last
Email
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone*
Office Phone*
Principal Owner or Stockholder 2
First Last
Email
Enter Email Confirm Email
Address
Street Address Address Line 2 City State ZIP Code
Cell Phone
Office Phone
The business is operated on real property which is:*
- Leased
- Owned by the business
Who is the owner/lessor of said property?
Real property where the business is located*

Trade Credit References
(Must Provide At Least Four)
Trade Credit Reference 1*
Credit Amount 1*
Address 1*
Street Address Address Line 2 City State ZIP Code
FAX 1*
Email 1*
Trade Credit Reference 2*
Credit Amount 2*
Address 2*
Street Address Address Line 2 City State ZIP Code
FAX 2*
Email 2*
Trade Credit Reference 3*
Credit Amount 3*
Address 3*
Street Address Address Line 2 City State ZIP Code
FAX 3*
Email 3*
Trade Credit Reference 4*
Credit Amount 4*
Address 4*
Street Address Address Line 2 City State ZIP Code
FAX 4*
Email 4*

Bank Reference
Bank Name 1*
Account Type*
- Checking
- Savings
Account Number*
Bank Address*
Street Address Address Line 2 City State ZIP Code
Bank Name 2*
Account Type*
- Checking
- Savings
Account Number*
Bank Address*
Street Address Address Line 2 City State ZIP Code
Credit Line
Total Amount of Credit Requested*
Monthly Amount*

Terms and Disclosure
IF CREDIT IS EXTENDED TO YOU OR YOUR BUSINESS THE FOLLOWING TERMS SHALL APPLY:

1. The undersigned (an authorized representative of the company requesting credit terms) agrees to all stipulations and criteria herein contained within this document. This is a legal and binding contract.
1. 1. NET DUE DATE — Purchases are due in full thirty (30) days from the date of the invoice.
2. 2. FINANCE CHARGES – Any account balance not paid in full by the Net Due Date will be accessed a finance charge. Finance charges will continue to accrue until the balance is paid in full. The finance charge will be computed on the past due portion of the account following the net due date. Finance charges are accessed at a Periodic Month Rate (PRM) of 1½%, equivalent to an Annual Percentage Rate (APR) of 18%.
3. 3. Baucom’s Nursery Company reserves the right to withdraw credit privileges without prior notice.
4. 4. Failure of the customer to pay as required on the net due date may result in the loss of charge status. The customer may be deemed Cash on Demand/Delivery (COD), and must pay in full, in the method established by Baucom’s Nursery Company prior to or at the time of delivery.
5. 5. If Baucom’s Nursery Company deems litigation is necessary to collect on this account, the customer agrees that they shall be liable for all costs, damages, interest and attorney’s fee, up to and including any appeal of this matter. The customer agrees that Baucom’s Nursery Company may file in whatever province they deem suitable. The customer waives any and all rights to select or determine the venue of litigation.
6. 6. It is understood and agreed that Baucom’s Nursery Company after reviewing this application may request a financial statement to be completed in detail. The undersigned understands the terms of sale, and agrees to comply with the policies and procedures established with the signing of this document if Baucom’s Nursery Company extends a line of credit.
The undersigned certifies that all the information on this form is correct and hereby agrees that all payment shall be made as set forth under the terms and disclosure set forth above,
Applicant's Signature*
Applicant's Name*
First Last
Applicant's Title*
Company represented*
Date*
MM slash DD slash YYYY
Witness' Signature*
Witness' Name*
First Last
Date*
MM slash DD slash YYYY

Agreement

For and in consideration of the sum of one dollar ($1.00) in hand paid to the undersigned by Baucom's Nursery Company, and in further consideration of the undersigned, Baucom's Nursery Company shall review and consider extending credit to the below named Guarantor. The undersigned unconditionally hereby guarantees payment of any and all debts which may be owed to Baucom's Nursery, hereafter by the below named Company, and upon demand of Baucom's Nursery Company and without requiring Baucom's Nursery Company to institute any legal action or to take any other type of action against the below named Guarantor.

The undersigned will pay the Baucom's Nursery Company the total amount of the indebtedness owed to Baucom's Nursery Company, plus interest at the highest statutory rate.
Company Name*
Guarantor's Signature*
Guarantor's Name*
First Last
Guarantor's Social Security Number*
Guarantor's Home Address*
Street Address Address Line 2 City State ZIP Code
Guarantor's Phone*

In-House Credit Application

We offer in-house credit to qualified wholesale nurseries.

If you would like to apply, please complete the application below:

Step 1 of 10

Company Information

Principal Owners or Stockholders of Business

Company Financial Information

Trade Credit References

Bank Reference

Credit Line

Terms and Disclosure

Billing Instructions

Accounts Payable Information

Agreement

Authorization

I do hereby authorize Baucom's Nursery Company to request and receive information about our account. I understand this is soley for credit determination and this information will be held in the strictest confidence.