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Name of Business
Legal (if different)
Address
City
State
 Zip
Phone
D & B Number
Credit Requested
Type of Business
In Business Since
 Tax ID #

Subsidiary or Parent Company (if selected):
Name Title Address Phone
Name of Bank
 Name of Contact
Branch
 Address
Telephone Number
 State
 Zip
Firm Name Contact Name Phone Open Acct Since
The applicant referred to above certifies that all information in this application is correct, and acknowledges and agrees that:

1. Information included in this credit application will be utilized to determine the amount (if any) and conditions of credit to be extended to applicant.
2. Other sources of credit information, including trade creditors and financial institutions, may be consulted in connection with this credit application. Said other sources are hereby authorized to release all information requested by Santal. Applicant hereby waives any and all claims, and releases said other sources from liability, as respects such disclosures including, without limitation claims and liability for violation of privacy rights (if any), defamation and disparagement. The original or a copy of this credit application may be provided to such other sources; and said other sources shall be deemed to be intended beneficiaries of this application.
3. If credit should be extended to applicant (which extension will be in Santal Solution’s sole discretion), then applicant agrees to the following additional conditions and covenants:

a) All invoices must be paid when due according to Santal Solution’s terms and conditions of sale then in effect. No prompt payment discounts will be allowed if payment is received beyond the discount date, and shipments may be delayed if invoices are past due.
b) Applicant shall pay all reasonable costs and expenses of collection including all legal fees and court costs.
c) Any dealings between the parties shall be governed by and interpreted in accordance with the laws of the State of Wisconsin without regard to conflicts of laws principles, and applicant further consents to the jurisdiction of the state courts, for Outagamie County, Wisconsin, to determine any controversy relating to said dealings.
d) Applicant hereby represents and warrants that there are no collection suits or tax claims pending against it at this time.
e) Santal Solution shall have the right to discontinue the extension of credit if there is a delinquency or commencement of bankruptcy or similar proceedings involving the applicant. The waiver of a default involving one or more of the provisions set forth above, shall not constitute a waiver of any subsequent default.

Name
 Title
 Date

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