Instruments & Equipment Company Credit Application 
(Please print and complete this form. This form requires a signature.) 

Company Name _______________________________________________________________________________

Address _____________________________________________________________________________________       

City _____________________________     State _____          Zip Code________________  

Accounts Payable Contact  ________________________ Telephone or Extension ___________________________

Purchasing Contact _____________________________  Telephone or Extension ___________________________

Technical Contact  ______________________________ Telephone or Extension ___________________________

Website Address __________________________________________________ 

  Corporation     Partnership       Proprietorship

Years in Present Business ________________________      Dunn & Bradstreet # ________________________  

Sales Tax/Use Tax Exemption Certificate Number:_________________________________________________
(Please Fax a Copy of This Year's Exemption Certificate Along with this Application)

Bank Name ______________________________________________________________________________     

Bank Address _____________________________________________________________________________         

City _____________________________     State _____        Zip Code __________________________________

Bank Telephone # _______________________________     Bank Fax #      ______________________________

Bank Contact Name ______________________________    Bank Account # _____________________________  

New Jersey law shall be applied to resolve all disputes between us, and you consent to submit to the jurisdiction of New Jersey’s courts in the event a dispute arises between us which we cannot resolve ourselves.  It is further understood and agreed to that if you fail to make payments owed to Instruments & Equipment Co. in connection with the orders you place, you will be in default.  If you default on payments, we will be entitled to all damages caused as a result of your default, and you shall be obligated to pay our costs of collection and reasonable attorney’s fees.   I also authorize the release of credit and banking information to Instruments & Equipment Company.

X_________________________________________________________
 Authorized Signature of Company Owner  or Corporate Officer

___________________________________                     _____________________________________
 Title/Position                                                                                Date

___________________________________                      ______________________________________
Printed Name                                                                             Social Security #

Please Fax (after signing) to:

Instruments & Equipment Co. - 2 Wilson Dr., Unit #1 - Sparta, NJ   07871 - Fax: 973-579-6665

Please fax your completed credit application to the above address for credit processing.  Please allow us 1 to 3 business days, after we receive your initial order, to process your credit application.

TRADE REFERENCES (Major Suppliers) Please complete all field including the FAX# field:
 

Company Name ______________________________________________________________________     

Address ____________________________________________________________________________     

City ______________________________  State _____          Zip Code ____________________________

Telephone # ___________________________________      Fax #     _____________________________

Contact Name __________________________________     Email _______________________________   

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Company Name ______________________________________________________________________      

Address ____________________________________________________________________________     

City ______________________________  State _____          Zip Code ____________________________

Telephone # ___________________________________      Fax #      _____________________________

Contact Name __________________________________     Email _______________________________   

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Company Name ______________________________________________________________________      

Address ____________________________________________________________________________     

City ______________________________  State _____          Zip Code ____________________________

Telephone # ___________________________________      Fax #    ______________________________

Contact Name __________________________________     Email _______________________________     

If you prefer, you may attach your own trade/credit reference list and fax it along with the first part of this credit application.

Personal Guarantee:

In consideration for Instruments & Equipment Co. extending credit to the business identified below, for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Instruments & Equipment Co. by the business identified below whether said sums are due under open account, contract or otherwise.

It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Instruments & Equipment Co. and the business.  Instruments & Equipment Co. shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Instruments & Equipment Co.

The guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by Instruments & Equipment Co.  Said notice shall specify the date on which this guaranty is to be terminated, said date not to be less than seven days after such notice is received.  Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination.

Date ____________________         Name ___________________________________________________________________
                                                                               (Name of person guaranteeing payment, NO TITLE)

Home Address _____________________________________     SSN# ____________________________________________

Signature of person guaranteeing payment ___________________________________________________________________

Name of business whose account is guaranteed ______________________________________________________________