Application for Credit Terms

AGREEMENT AND DECLARATION

The signing of this application authorizes DataQDirect (Secured Party) to perform the necessary credit investigation on the above company. I authorize the above references to release information necessary for DataQDirect or a DataQDirect Agent to make an informed credit decision. DataQDirect is authorized to make all inquiries deemed necessary to determine our creditworthiness. DataQDirect or Assigned agent is authorized to answer questions about their credit experience with us, and share this information with other institutions to secure financing.

To secure payment for all purchases from Secured Party, now and in the future, Client/Debtor hereby grants Secured Party a continuing security interest in all Client/Debtor’s presently owned or hereafter (a) goods, (b) instruments, (c) Chattel paper, (d) documents, (e) accounts, (f) accounts receivable, (g) general intangibles, and (h) payment intangibles and together with all proceeds and all support obligations thereof. The following constitute Client defaults: Non-payment in timely fashion of Client’s indebtedness to DataQDirect, bankruptcy, insolvency, or Assignment for the benefit of creditors; misrepresentation in respect of any provision of this or any Agreement between DataQDirect and Client. In the event of default DataQDirect may declare all unpaid balances due. Client authorizes Secured Party to file a UCC Financing Statement (or PPSA if Canadian Client) describing the collateral for the purpose of protecting Secured Party’s interest. However, at DataQDirect’s discretion, UCC (or PPSA if Canadian Client) may or may not be filed.

The information contained herein is submitted by Client for the purpose of obtaining credit. Client expressly agrees to make payment in full within the approved terms to DataQDirect for the purchases in accordance with invoice(s). Should Client default in any such payment, all amounts owed DataQDirect by Client shall become immediately due and payable. Client further agrees to pay a reasonable attorney’s fee and all other costs and expenses incurred by Client in the collection of any obligation of Client pursuant hereto. This agreement shall become effective when accepted by Client.

*A Processing fee of $45.00 will be charged to the below listed Credit Card for processing of this application. Waiver of application fee will be made upon approval of terms AND WILL BE applied to your first On-Line order with DataQDirect.  If during the credit Review process you are denied credit terms for any reason the processing fee will not be refunded. By checking the box below you agree to all the above listed terms and conditions.

Please Note that the approval process may take up to 72 hours

DATAQDIRECT.COM

CREDIT APPLICATION FOR A NEW ACCOUNT

COMPANY INFO
Company Name  
Phone  
Fax  
E-mail  
Registered Co. Address  
City  
State  
Zip Code  
Date Business Commenced  
Type of Business  
Your Name  
Your DataQDirect Website Registration ID  
ACCOUNTING CONTACT
Name  
Title  
Phone  
Fax  
E-mail  
BUSINESS AND CREDIT INFORMATION
Bank Name  
Bank Address  
City  
State  
Zip Code  
Account Type (1) Savings Checking Other  
Account Number  
Account Type (2) Savings Checking Other  
Account Number  
Dun and Bradstreet  
CREDIT CARD FOR PROCESSING APPLICATION (*45.00 FEE)
Card Number  
Cardholder Name  
Billing Address  
Expiration Date  
Security Code  
AGREEMENT & DECLARATION
I agree to the above terms  
Submit Application