Tire Credit Application - Northwest Tire TreadSearch

Name of the person completing this form(Required)

First Last

Email(Required)

Copy sent to this email

Date(Required)

Estimated Purchases Monthly(Required)

Legal Name(Required)

DBA Company Name

Contact Person

First Last

Address(Required)

Street Address City State ZIP Code

Phone Number(Required)

Fax Number

Invoices and statements emailed?(Required)

Yes

No

Would you like invoices and statements emailed?

Invoices Email Address

example@example.com

Statements Email Address

example@example.com

Are you reselling(Required)

Yes

No

Type of Firm(Required)

Sole Proprietor

Partnership

Corporation

LLC

Date Business Founded(Required)

How long at present location(Required)

If at present location less than 3 years enter previous location

State sales tax exemption number

Primary Warehouse / Loc. Ordering From

Salesman (if known)

Attach tax exemption certificate

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 16 MB.

Federal ID#(Required)

PO required?

Yes

No

If incorporated, name of state in which incorporated and date incorporated

Financial statement attached(Required)

Yes

No

Financial Statement Upload

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 16 MB.

If no, please explain(Required)

Description of business

INFORMATION ON OWNER(S) OR PRINCIPAL OFFICERS:

Title (1)(Required)

Name (1)(Required)

First Last

Phone (1)(Required)

Social Security # (1)

Format: 123-12-1234

Address(Required)

Street Address Address Line 2 City State ZIP Code

PRINCIPAL OFFICER (2)

Title (2)

Name (2)

First Last

Phone (2)

Social Security # (2)

Format: 123-12-1234

Address (2)

Street Address Address Line 2 City State ZIP Code

Have any of the above been in other businesses?(Required)

Yes

No

If so, under what name?

I/WE HAVE SUPPLIED THE INFORMATION, AND I UNDERSTAND AND AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

This agreement, and all rights and obligations of the parties hereto shall be governed by the laws of the State of North Dakota. Buyer agrees that said contract is not deemed accepted until approval has been rendered by Seller’s credit office in Bismarck, ND. I certify the information given is correct and understand it will be kept confidential. The undersigned authorizes the named credit references and bank reference to provide Northwest Tire Inc. with any credit or financial information it requests; and authorizes Northwest Tire Inc. to contact and obtain information from credit reporting agencies. I further understand my monthly account is a NET charge. All invoices are due by the 10th of the following month unless special terms are noted on purchase order, order blank or invoice. I/We hereby agree to pay reasonable collection costs, attorney’s fees and court costs, if necessary, to collect any unpaid bills; and agree to pay a finance charge of one and one-half percent (1 1/2%) per month on past due moneys. Applicant’s signature attests financial responsibility and willingness to pay our invoices in accordance with our terms.

Signature(Required)

I hereby affirm that my digital signature, applied by me to this document, holds the same legal validity and enforceability as my handwritten signature. By applying my digital signature, I consent to be legally bound by the terms and conditions of this document.

Title(Required)

Date(Required)

CREDIT REFERENCES

BANK REFERENCES:

Name of Bank & Branch(Required)

Bank Phone Number(Required)

Bank Address(Required)

Street Address Address Line 2 City State ZIP Code

Bank Fax Number

Officer to Contact(Required)

First Last

Checking acct. #

TRADE REFERENCES:

Business (1)(Required)

Contact(1)(Required)

First Last

Phone (1)(Required)

Address (1)(Required)

Street Address City State ZIP Code

Fax Number (1)

Account # (1)

TRADE REFERENCE (2):

Buisness (2)

Contact (2)

First Last

Phone (2)

Address (2)

Street Address Address Line 2 City State ZIP Code

Fax Number (2)

Account # (2)

TRADE REFERENCE (3):

Business (3)

Contact (3)

First Last

Phone (3)

Address (3)

Street Address Address Line 2 City State ZIP Code

Fax Number (3)

Account # (3)

PERSONAL GUARANTEE

1. For value received, the undersigned, herein called guarantors, jointly and severally, unconditionally guarantee and promise to pay to Northwest Tire Inc., 1615 Bismarck Expressway, Bismarck, ND 58504, or any of its affiliates, successors or assigns, herein called “Seller”, any indebtedness incurred on or after 03-21-2024, by (your company name) NA herein called “Buyer”, by reason of the purchase from Seller of all tires, wheels, and accessories purchased from Northwest Tire Inc. or any of its affiliates, successors or assigns.

2. Guarantors understand and agree that this is a continuing guaranty, and until revoked as provided for in this instrument, shall cover all future indebtedness arising under successive transactions that shall either continue the liability of principal or from time to time renew it after it has been satisfied.

3. This guaranty shall terminate on delivery to and acceptance by Seller, at the address set forth above, of notice of termination effective as to any and all indebtedness incurred or created by Buyer from and after such delivery of notice of termination. Termination of personal guaranty may, at Seller’s discretion, affect the amount of or the ability to obtain credit with the Seller. Seller’s acceptance is effective upon a written reply notice to Buyer.

Name

First Last

Social Security # (1)

Format: 123-12-1234

Signature (1)

I hereby affirm that my digital signature, applied by me to this document, holds the same legal validity and enforceability as my handwritten signature. By applying my digital signature, I consent to be legally bound by the terms and conditions of this document.

Date of Birth (1)

PERSONAL GUARANTEE (2)

Name

First Last

Social Security # (2)

Format: 123-12-1234

Signature (2)

I hereby affirm that my digital signature, applied by me to this document, holds the same legal validity and enforceability as my handwritten signature. By applying my digital signature, I consent to be legally bound by the terms and conditions of this document.

Date of Birth (2)

Application for Credit

Locations

INFORMATION ON OWNER(S) OR PRINCIPAL OFFICERS:

PRINCIPAL OFFICER (2)

CREDIT REFERENCES

TRADE REFERENCES:

TRADE REFERENCE (2):

TRADE REFERENCE (3):

PERSONAL GUARANTEE

PERSONAL GUARANTEE (2)

Certificate of Exemption