Commercial Credit Application

Please fill out the below form thoroughly and completely to be considered for Commerical Credit. Estimated time to process these applications – 7 to 10 business days.

Please do not hesitate to contact us if you have any questions refor any questions or concerns.

Houston Vibrator, Ltd.
PO Box 801882
Houston, TX 77280-1882
Phone: 713-939-0404
Email: ar@houstonvibrator.com

Business & Credit Information

Business Name(Required)

Federal EIN(Required)

DUNS Number

Business Phone Number(Required)

Email(Required)

Registered Address(Required)

City(Required)

State(Required)

Country(Required)

Zip Code(Required)

Business Website(Required)

Primary Business Activity(Required)

Years in Business(Required)

Number of Employees

Ownership Type(Required)

If LLC or Partnership List Owners, with Titles and Percentage of Ownership

Have You Filed for Bankruptcy in the last seven years?(Required)

Do You Have a Pending Order?(Required)

What Is The Pending Order Amount? (US Dollars)

Purchasing Information

Primary Buyer(Required)

Mailing Address (If Different from Above)

City

State

Zip Code

Email(Required)

Telephone(Required)

Invoice Delivery Preference (Select One)(Required)

Please Deliver Invoice to:

Please Fax Invoice To:

Please Specify Portal Address

Billing Information

Accounts Payable Contact (First and Last Name)(Required)

Email(Required)

Phone(Required)

Address

City

State

Zip Code

Please Specify How You'd Like Your Invoice Delivered:

Preferred Payment Method(Required)

Banking Relationships & Loans

Bank Name(Required)

Account Number(Required)

Contact Name (First and Last)(Required)

Phone Number(Required)

Fax

Bank Address

Type of Account(Required)

Business / Trade References

Accepted references here include industrial parts suppliers or material suppliers. Please DO NOT include freight companies. THREE distinct references are required.

Reference 1

Company Name(Required)

Company Contact

Location

Phone(Required)

Email(Required)

Reference 2

Company Name(Required)

Company Contact

Location

Phone(Required)

Email(Required)

Reference 3

Company Name(Required)

Company Contact

Location

Phone(Required)

Email(Required)

Agreement

Applicant and/or Company certifies that information contained in this application is true and correct, and authorizes Houston Vibrator, Ltd. to inquire into and obtain from any bank, lending institution, credit reference, or consumer or commercial credit reporting agency, information relating to the Applicant and/or Company’s creditworthiness or financial condition. If credit is extended, Applicant and/or Company agrees that such extension of credit shall be subject to the following terms and conditions, and that delinquency of account shall result in suspension or revocation of credit: Payment of invoices is due 30 days from date of invoice unless otherwise specifically agreed to in writing by credit manager; Past due balances will be subject to finance charges of 1% per month, 12% APR, or maximum allowable by law, which is not usurious in nature, as defined by the statutes of the State of Texas; In the event that third party collection effort is required, applicant agrees to pay customary and reasonable costs and fees, and interest on the debt not to exceed the maximum allowed by law; All actions between the parties (including guarantors) shall exclusively be governed by the laws and statutes of the State of Texas. Jurisdiction and venue for the resolution or disposition of any disputes of litigation shall exclusively be in Harris County, Texas. Applicant agrees to notify Houston Vibrator, LTD. in writing of any significant changes to the information provided herein.

Personal Guaranty

In consideration of Houston Vibrator, Ltd.(hereinafter referred to as “Creditor”) extending credit to the Applicant and/or the above named firm(herein referred to as “undersigned guarantor(s)”), hereby personally guarantee(s) the full and prompt payment to Creditor of all amounts hereafter due on the account, and the performance under the terms of the “AGGREEMENT”. The undersigned guarantor(s) aggress(s) and acknowledge(s) that Creditor has relied on this personal guaranty in agreeing to extend credit to Applicant(s) and/or Company, and expressly waive(s) all notice and acceptance of this guaranty, notice of extension of credit, presentment of demand for payment, and any notice of default by the Applicant(s) and/or Company seeking credit and all other notices the undersigned guarantor(s) might otherwise be entitled to. In the event of default by the Applicant(s) and/or Company in making any payment when due, the undersigned guarantor(s) hereby agree(s) to pay on demand all sums then due including any applicable late charges, and all losses or expenses which may be incurred by the Creditor, including but not limited to reasonable attorney’s fees.

Form Completed By:

Name(Required)

Email(Required)

Phone(Required)

Upon submitting this form you will receive documents to complete and submit a digital signature.

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