Credit Application for EVS Supply

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email

Name of Owner, Partner, or Chief Executive Officer

Bank Name

Branch Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Consent

Personal Guarantee

The undersigned hereby agrees to the terms and conditions of
sale, applicable at the time of order, and further accepts personal
responsibility for payment of monies due EVS for same. If at any time,
for any reason, the undersigned is unable to pay for purchases when
due, without prejudice to the right of EVS to immediate payment per
terms of sale, the undersigned agrees to pay and authorizes EVS to
bill the account a service charge monthly up to the maximum rate
allowed by law. In the event it becomes necessary for EVS to incur
collection costs or institute suit to collect any amount due on the
account, the undersigned promises to pay such additional collection
cost, charges, and expenses, including reasonable attorney’s fees
if the account is placed for collection. I clearly understand that the
information given is subject to audit and review by EVS, further that
the credit extended under this application is subject to revocation.

Name

First Last

Date