Main office:
Waldo Bros. Company
202 Southampton Street
Boston, MA   02118-2789
Tel: (617) 445-3000      Fax: (617) 427-5691

       Connecticut office:
       Waldo Bros. Company
       595 Nutmeg Road North
       South Windsor, CT 06074-2461
       Tel: (860) 289-9500      Fax: (860) 291-8500

CREDIT APPLICATION

TO PRINT THIS FORM: Click on FILE top left corner of screen. Then click on PRINT on dropdown menu. Follow print
 instructions. Either fax or mail the completed form (2 pages) to the office of your choice.
The undersigned company is applying for credit with and agrees to abide by the standard terms and conditions of as printed on page two of this document.

Company Name:

DBA (if different):

Contact Person:

Address:

Phone:                                                                                                               Fax:

Federal tax ID or social Security number:

Type of business:                                                                                              Number of employees:

Date business established

Amount of credit requested:

Are you a corporation:                   Yes            No

State of Incorporation:

Names, titles, and addresses of your three chief corporate officers:

1.

2.

3.

Name and address of your resident agent:

Partnership:               Yes             No

Names and addresses of partners:

Sole proprietorship:                                               Yes               No

Are you sales tax exempt?                                    Yes               No

Have you ever had credit with us before?         Yes               No

If yes, under what name:

Names of authorized purchasers:

Purchase order required?                   Yes               No

TRADE REFERENCES:

Reference 1: Name:

                   Address:

                     Phone:                                                                                         Fax:

Reference 2: Name:

                   Address:

                     Phone:                                                                                         Fax:

Reference 3: Name:

                   Address:

                     Phone:                                                                                         Fax:

BANK REFERENCES

Bank 1:  Account number:

                   Name of  bank:

                             Address:

                                 Phone:                                                                             Fax:

                   Contact person:

Bank 2:    Account number:

                   Name of  bank:

                             Address:

                                 Phone:                                                                              Fax:

                   Contact person:

I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose any and all information concerning the financial and credit history of my company and myself.

I have read the terms and conditions stated below and agree to all of these terms and conditions.

AUTHORIZED SIGNATURE:

Printed name:

Title:                                                                   Date:

General terms & conditions and personal guarantee:

1. Terms are 1% ten days net 30 days.`

2. A service charge of 2% per month will be added to all amounts billed if not paid by the end of the month.

3. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department.

4. Personal Guarantee: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.