Martin's Nursery, Inc.
2700 Snow Road
Semmes, Alabama 36575
(251) 649-0104
Fax (251) 649-0169
Application for Credit
Name: ____________________________
Street Address: ____________________________
City: ____________________________
Zip: ____________________________
Name of Owner: ____________________________
Federal ID#: ____________________________
   
   
State: ______________
Telephone: (___)____-_____
   
State Tax #: ______________
Trade References
1. Company Name: _______________________________
Adress: _______________________________
City: _______________________________ State: ________ Zip: _______
Telephone: _______________________________
Fax: _______________________________
2. Company Name: _______________________________
Adress: _______________________________
City: _______________________________ State: ________ Zip: _______
Telephone: _______________________________
Fax: _______________________________
3. Company Name: _______________________________
Adress: _______________________________
City: _______________________________ State: ________ Zip: _______
Telephone: _______________________________
Fax: _______________________________
Banking Reference
Name of Bank: ______________________________________________________
Address: ______________________________________________________
Telephone: ______________________________________________________
Contact: ______________________________________________________
Account Number: ______________________________________________________

Customer herein attests that it agrees to pay all accordance with the following terms, and does herein acknowledge that Martin's Nursery, Inc. does rely on such agreements by customer in having goods shipped upon request: All sums are due and owing immediately upon 30 days after date of invoice. Any amount not paid on or before thirty (30) days from the date of invoice shall be subject to a finance charge of one and one-half percent per month (an annual percentage rate of eighteen (18) percent until paid in full. Customer further acknowledges that the customer shall pay all cost and expenses involved with enforcing this agreement. Applicants signature attests financial responsibility, ability and willingness to pay our invoice in accordance with the above terms.
THE ABOVE INFORMATION IS FOR THE PURPOSE OF OBTAINING CREDIT AND IS WARRANTED TO BE TRUE. I/WE HEREBY AUTHORIZE THE FIRM TO WHOM THIS APPLICATION IS MADE TO INVESTIGATE THE REFERENCE LISTED PERTAINING TO MY/OUR CREDIT AND FINANCIAL RESPONSIBILITY.

Customer: ________________________________________ Date: ________________
 
Signature: ________________________________________ Title: ________________