1. Business Information

Full legal business name *

Main billing contact (first, last name) *

Billing address 1 *

Billing address 2 (suite #, apt #, unit #)

Billing city *

Billing state *

Billing zip *

Is physical address and billing address the same? *

Physical address 1 *

Physical address 2 (suite #, apt #, unit #)

Physical city *

Physical zip *

Billing contact phone number *

Billing contact email address *

Hidden

Type of ownership *

Fed Tax ID or SSN *

D-U-N-S Number

2. Company Financial Information

How many years in business? *

Total sales in the last 12 months ($) *

Average monthly supplies/inventory purchase ($) *

Credit amount requesting ($) *

Has your company ever defaulted on a payment? *

Please indicate payment amount and why *

3. Principal Information (individuals with at least 25% equity in company)

#1 Principal first name *

#1 Principal last name *

#1 Principal company title *

#1 Principal home address 1 *

#1 Principal home address 2 (suite #, apt #, unit #) *

#1 Principal home city *

#1 Principal home state *

#1 Principal home zip *

Is there another principal with 25% or more equity in the company? *

#2 Principal first name *

#2 Principal last name *

#2 Principal company title *

#2 Principal home address 1 *

#2 Principal home address 2 (suite #, apt #, unit #) *

#2 Principal home city *

#2 Principal home state *

#2 Principal home zip *

4. Trade References (3 required)

#1 trade reference company name *

#1 trade reference contact name (first, last) *

#1 trade reference address 1 *

#1 trade reference 2 (suite #, unit #)

#1 trade reference city *

#1 trade reference state *

#1 trade reference zip *

#1 trade reference phone *

#1 trade reference email

#2 trade reference company name *

#2 trade reference contact name (first, last) *

#2 trade reference address 1 *

#2 trade reference address 2 (suite #, unit #)

#2 trade reference city *

#2 trade reference state *

#2 trade reference zip *

#2 trade reference phone *

#2 trade reference email

#3 trade reference company name *

#3 trade reference contact name (first, last) *

#3 trade reference address 1 *

#3 trade reference address 2 (suite #, unit #)

#3 trade reference city *

#3 trade reference state *

#3 trade reference zip *

#3 trade reference phone *

#3 trade reference email

5. Bank Reference

Bank name *

Bank Phone *

Credit inquiry contact name (first, last) *

Bank address 1 *

Bank address 2 (suite #, unit #)

Bank city *

Bank state *

Bank zip *

Bank account # *

Is this a business or personal account? *

Is this a checking or savings account? *

Authorization & Signature

I agree.

We, the named company, are authorizing Metpure Inc., and/or 3rd party business credit verification institutes authorized by Metpure Inc., to obtain credit report, bank reference, and trade reference verifications.

I agree.

I certify that the named company hereby makes application for credit and provides the information contained herein, which is warranted to be true and correct, for the purpose of inducing Metpure Inc. to provide goods and services to it on credit. In consideration thereof, it is agreed and understood that (1) the undersigned is an authorized agent of the applicant and is duly empowered to enter into and make binding agreements on behalf of the named company, (2) the above named company is given permission to Metpure Inc, and/or 3rd party business credit verification institutes authorized by Metpure Inc., to run all necessary verifications on, including, but not limited to, business and principals financial background, credit score, trade references, and bank references, in order to determine the amount and term of credit to extend to the above named company, if any, (3) all accounts are payable in full within the term from date of invoice; (4) a monthly service charge of 1.5% may be charged on all sums past due, or the maximum allowed by law, if lower. All payments shall be made to Metpure Inc. at 4773 Brooks St., Unit D., Montclair, CA 91763; (4) in the event of default of payment when due, all costs of collection, including attorney’s fees and court costs, shall be paid by the applicant; and (5) all business disputes arising or related to the Parties must exclusively be resolved first by mediation with a mediator selected by the Parties, with such mediation to be held in Los Angeles County, California. (6) If such mediation fails, then any such dispute shall be resolved by binding arbitration in the State of California under the Commercial Arbitration Rules of the American Arbitration Association, and (7) the Parties hereby irrevocably submit to the exclusive jurisdiction of any California state court or Federal court located in the County of Los Angeles and (8) any credit extended, payment term, or payment methods to applicant may be altered, reduced, or eliminated in the event Metpure Inc., in its reasonable discretion, determines that applicant’s financial situation or ability to pay is impaired.

Signature *

The undersigned must be an authorized agent of the applicant and is duly empowered to enter into and make binding agreements on behalf of the named company.

SUCCESS!

The creidt application has been successfully submitted.

Please allow 7-10 business days to receive a status on the credit term.

Check your email including junk/spam forlders.

For any questions,

please e-mail us at

support@metpure.com

or call our

customer service at

714-202-0019

SUCCESS!

The creidt application has been successfully submitted.

Please allow 7-10 business days to receive a status on the credit term.

Check your email including junk/spam forlders.

For any questions,

please e-mail us at

support@metpure.com

or call our

customer service at

714-202-0019

Credit Term Application

1. Business Information

2. Company Financial Information

3. Principal Information (individuals with at least 25% equity in company)

4. Trade References (3 required)

5. Bank Reference

Authorization & Signature

SUCCESS!

SUCCESS!

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		Subtotal	$0.00
		Shipping
		Total

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