264 N. Industrial Drive
Frontenac, KS 66763
http://www.wisp-router.com
Phone 620-231-7777
Fax 620-231-4066
WISP-Router, Inc.
Dear Customer:
Please find attached the Customer Credit Application for WISP-Router, Inc. Please note that this form
must be completed in it’s entirety with the exception of the following:
1) A pre-printed list of vendor credit references can be attached in lieu of filling out our form;
please be sure to include your banking information if you are using your own list, or make sure
that the banking information is filled out on our form.
2) The Personal Guarantee need not be signed if your company is a Corporation. However, if your
company is a sole proprietorship or an LLC, this form MUST be signed by the owner or all of
the managing partners of the LLC. There are no exceptions.
3) The Agreement to our Terms and Conditions MUST be signed by an officer of the corporation
who has the authority to bind your company to such a contract.
Failure to provide the necessary information will result in your application being delayed.
In addition to the above, we would like to give you some of the criteria that we employ in determining
credit worthiness to our company:
1) We will review your payment history with other vendors. Those that habitually do not pay
within the terms offered for several of the credit references provided will result in a rejection of
your credit application.
2) We also take into consideration the length of time we have had a business relationship under
other terms. First time customers will not be granted credit, and should have a history with
WISP-Router, Inc. for a minimum of three months with other payment methods being employed.
3) We do check with all of the supplied trade references. Please note that references for services
(i.e., telephone, internet, electric, etc.) will not be considered as credit references. Please make
sure your references are for equipment and/or other tangible items.
If you have any questions, please do not hesitate to ask. Thank you for your cooperation.
Regards,
Beverly Gustafsson
CFO – WISP-Router, Inc.
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264 N. Industrial Dr., Frontenac, KS 66763
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Phone:
(620)
231-7777
Fax:
(620)
231-4066
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Complete Legal NameTelephone ( )________________________________ Fax ( )________________________________
Business Address City State Zip
Mailing Address City State Zip
Since Credit Requested (circle one)*
Net 20 Terms COD Company Check DUNS Number: Amount of Credit Requested:*
*
Failure to disclose will delay your application.B
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Corporation, Publicly held Corporation, Privately held Partnership, General
Division or Subsidiary Sole Proprietorship Partnership, Limited
Name of Parent Corporation________________________________________________ State of Incorporation______________ Address________________________________________________________________ If a Corporation, please attach appropriate documentation to substantiate corporate City, State, Zip__________________________________________________________ status
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Social Security No._______________________________________ Tax Exempt? Yes No (if yes, attach certificate) Federal Tax No.__________________________________________ Resale/Use Tax No.___________________________________
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(attach additional sheets for each additional bank references)
1. Name_____________________________ Contact Officer______________________________
Address___________________________ Telephone__________________________________
City, State, Zip_____________________ Fax_______________________________________
Checking Account No._______________ Savings Account No._________________________
Balance_________No. Overdrafts______ Balance____________________________________
Loan No.__________ Business Personal Balance__________ Secured? Yes No
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(Please make sure that the companies listed below are willing to provide credit references, or
processing of your credit application could be delayed – Electric or Phone companies are NOT acceptable as Trade
References)
1. Name___________________________________ Contact Person____________________________ Terms________________
Address________________________________________ Customer Since____________________ Balance_______________
City, State, Zip_______________________________ Last Invoice Date_______________ Pmt History_________________
Telephone________________________________ Fax_____________________________ Credit Limit_________________ 2. Name___________________________________ Contact Person____________________________ Terms________________
Address________________________________________ Customer Since____________________ Balance_______________
City, State, Zip_______________________________ Last Invoice Date_______________ Pmt History_________________
Telephone________________________________ Fax____________________________ Credit Limit__________________ 3. Name___________________________________ Contact Person____________________________ Terms________________
Address________________________________________ Customer Since____________________ Balance_______________
City, State, Zip_______________________________ Last Invoice Date_______________ Pmt History_________________
Telephone_________________________________ Fax____________________________ Credit Limit__________________
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s (Responsible for business transactions – if partnership, attach additional sheets if necessary
to list ALL Members of the Partnership)Name_________________________________________ Position__________________________________ % ownership_______ Home Address_____________________________________ Telephone__________________________ SS No.________________ Name_________________________________________ Position__________________________________ % ownership_______ Home Address____________________________________ Telephone___________________________ SS No.________________ Name_________________________________________ Position__________________________________ % ownership_______ Home Address____________________________________ Telephone___________________________ SS No.________________
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Does business have any debts under a name other Do you require a purchase order? Yes No than the one used on this credit application?
Do you use purchase order numbers? Yes No Yes No
Please list the person(s) or position(s) authorized
If Yes, list name__________________________________ to issue P.O.s:_____________________________________________
Does business have any past due debts? ________________________________________________________ Yes No (Please attach additional sheets if necessary)
If Yes, where?____________________________________
Estimated monthly purchases_________________________________ Has business ever filed for bankruptcy?
Will you send a confirming purchase order on Yes No phone orders?
This contract shall be constructed to have been made and entered in Frontenac, Kansas, on the date subscribed below, by and between WISP-Router, Inc., a Kansas corporation, herein after referred to as “WISP-Router, Inc.”, and “Applicant(s)” for the purpose of establishing an open account for applicant under terms and conditions as follows:
1. Applicant, whether maker, endorser, surety or guarantor (all of whom are included in the term (“Applicant”) applies for credit and agrees to be bound hereunder and make payment as may be specified within any Invoice or Statement received from WISP-Router, Inc.; examples COD, Net 10 days, etc., as may be determined by WISP-Router, Inc. from time to time. Approval of credit and continuation of the account is discretionary with WISP-Router, Inc., which discretionary authority may be entirely arbitrary in its exercise. In consideration for WISP-Router, Inc. establishing an open account and possibly extending credit to the Applicant on a revolving basis, Applicant agrees to be bound by the terms and conditions specified herein or as modified by any WISP-Router, Inc. Invoice or Statement hereafter. Applicant acknowledges, understands and consents to the fact that WISP-Router, Inc. may, through change of the Terms and Conditions evidenced within any Invoice or Statement from time to time, modify the Contract Terms and Conditions herein from time to time with or without notice. Applicant waives any and all claims Applicant may have and agrees to hold WISP-Router, Inc. harmless for any decision WISP-Router, Inc. may make as to maintenance of an account with Applicant or the modification of payment conditions and terms.
2. All right, title and interest in and to all property delivered to Applicant shall remain with WISP-Router, Inc. until fully paid. Payment shall, whether in whole or in part, be applied on a first delivered, first paid basis.
3. This agreement shall be governed under the laws of the State of Kansas. Ay action brought under this Agreement or involving in any manner whatsoever the relationship WISP-Router, Inc. and Applicant shall be determined under Kansas law. Applicant hereby consents to submit to jurisdiction of the state or federal courts of the State of Kansas and agrees that such Courts within Crawford County, State of Kansas, shall have original exclusion jurisdiction over all matters and disputes between the parties hereto regardless of the origin of such disputes and agrees that personal jurisdiction shall reside with such courts for purposes of any action or proceeding on or related an agreement between WISP-Router, Inc. and Applicant. Should Applicant be a corporation or other business entity, the signatories hereto personally guarantee, affirm, and assure that they have authority to bind such business entity. 4. Applicant shall be in default if any of the following events occur: (a) upon WISP-Router, Inc. deeming itself insecure; or (b) upon
Applicant’s failure to make payment at the time when and where the same become due and payable; or (c) upon Applicant’s failure to perform any other obligation to WISP-Router, Inc., or (d) upon the death or insolvency (however evidenced) of Applicant; or (e) upon the commission of an act of insolvency or the making of a general assignment for the benefit of creditors by Applicant; or (f) upon the filing of any petition or the commencement of any proceeding by or against the Applicant for any relief under any bankruptcy or insolvency laws, or any laws relating to the relief of debtors, readjustment of indebtedness, reorganization, compositions or extensions; or (g) upon the suspension of the transaction of the usual business of the Applicant; or (h) upon the dissolution, merger, consolidation or reorganization of Applicant; or (i) if any representation or warranty, whether oral or written, by Applicant to WISP-Router, Inc. be materially untrue. Upon default, WISP-Router, Inc. may retake its property by any peaceable means and to do so can enter any of Applicant’s properties.
5. In the event of any such default, Applicant (a) agrees to pay WISP-Router, Inc. all lawful collection costs and legal expenses, including reasonable attorney’s fees, with or without suit; (b) agrees that any Invoice or Statement at the rate of 1.5% compounded monthly (18% per anum) until date paid. Waiver of any default shall not constitute a waiver of any subsequent default.
6. Execution of this Contract authorizes WISP-Router, Inc. to verify with credit reporting agencies, any information or representation which may be provided in the statement and to exchange WISP-Router, Inc. credit experience with credit reporting agencies, other creditors of the Applicant or others.
7. Router, Inc. is hereby authorized to contact the references provided, banks listed hereon and any other source deemed by WISP-Router, Inc. to be material and obtain any information in such files pertaining to any and all funds, accounts, records, history, accounting, deposits, withdrawals and / or all related or additional information. Such persons are hereby directed to release information upon request. WISP-Router, Inc. and the repository of records; agency; any employer, or business establishment including its officers, employees, or related personnel both individually and collectively, are hereby released from any and all liability for damages of whatever nature caused by or resulting from compliance with this authorization and request for information or any attempt to comply herewith.
Applicant hereby certifies that the information given on this application is true, complete and correct. Applicant understands that WISP-Router, Inc. will rely on the truthfulness, and completeness in granting credit to the applicant. Applicant further certifies that they fully understand all terms and provisions of this contract and has received a copy of this contract.
Print Name and Title: __________________________________________
Signature: ___________________________________________________ Date: _______________
Print Name and Title: __________________________________________
Signature: ___________________________________________________ Date: _______________
(Note: Signatures must be Officers if a corporation. All partners must sign.)
Personal Guarantee
(Must be signed only if company is a Sole Proprietorship or Partnership)
For good consideration, and as an inducement for WISP-Router, Inc. (Creditor) to extend business terms to
__________________________________________________ (“Applicant”), it is hereby agreed that the undersigned
(Insert either your business name or your name here for this to be a valid document)
