Business Credit Reports

Company Information

Company Name

Date Established

DBA

Address

City

State/Province

Zip/Postal Code

Country

Business Phone

Business Fax

Web Address

Type of Business (Corporation/Partnership/Proprietorship/LLC/Government)

Line of Business

SIC Code

FID #

Tax ID #

State of Incorporation

Which Veseris Location Will You Be Purchasing From? (City/State)

Estimated Line of Credit Required

Requested Terms

Is this a tax exempt purchase/service? (Yes/No)

If yes, which state(s) will the product be used?

Contact Information

First Name

Last Name

Title

Phone

Accounts Payable Contact Information

Contact Name

Phone

Invoicing Method (Email/USPS/Fax/EDI)

Payment Method (Check/Wire or ACH/Credit Card)

If Corporation/LLC - Officers & Registered Agent Information

Officer #1 Name

Officer #2 Name

Officer #3 Name

Registered Agent Name

Registered Agent Address

If Partnership/Proprietorship - Owner Information

Owner #1 Name

Owner #1 Address

Owner #1 City

Owner #1 State

Owner #1 Zip

Bank Reference

Bank Name

Account Number

Contact Name

Phone

Trade Reference #1

Company Name

Address

City

State

Zip

Phone

Fax

Trade Reference #2

Company Name

Address

City

State

Zip

Phone

Fax

Trade Reference #3

Company Name

Address

City

State

Zip

Phone

Fax

Signer Information

Name

Title

Date

Supporting Documentation

Please upload a copy of your Financial Statement and your Tax Exemption Certificate for each state/local jurisdiction where the product will be used.

Click the Browse / Choose Files button above to select the files you want to send. Then click the Upload button.
Please keep individual file sizes to 4MB or less.

Uploaded Documents

Terms

1. Applicant agrees that any extension of credit is subject to the terms and conditions in the Application and invoices issued to Applicant. Applicant further agrees that all orders or purchases are subject to ES OpCo USA LLC’s Standard Terms and Conditions of Sale as of the date of shipment available at https://www.veseris.com/sales-terms. All sales and orders are expressly limited to such terms, which may be updated from time to time. No other terms and conditions other than as referred to or stated herein apply unless agreed to in writing by both parties.

2. If ES OpCo USA LLC (“Seller”) agrees to extend credit, all decisions regarding the granting or continuation of credit are at the sole discretion of Seller and may be terminated at any time. Applicant authorizes Seller to contact credit reporting services and other third parties to determine Applicant’s creditworthiness. Applicant warrants that it is solvent. Continued solvency is a precondition to any sale made by Seller. Applicant agrees to update this Application and provide updated financial statements upon request.

3. Acceptance of goods, without notification of dispute or defect pursuant to notice requirements and procedures set forth in the Standard Terms and Conditions of Sale will be deemed an absolute and will deem all such unresolved credit items to be in error and the property of the Seller.

4. Payment terms are as stated in the invoice and the Standard Terms and Conditions of Sale. Past due balances are subject to a late payment charge of 1.5% per month, or the highest rate allowed by law, if lower. Applicant shall pay all charges, costs and legal fees incurred in collecting amounts owed.

5. Applicant authorizes Seller, its successors and assigns, by its designated attorney, to waive the issuance of service of process and confess judgment against it for the entire unpaid balance of applicant’s account, together with all cost applicable to such action.

6. This Application and any dispute arising from it will be governed by the laws of the state of Texas. The parties agree that Travis County, Texas is the appropriate venue for such an action. By the signature below, the applicant states that it has read, understands and agrees to the terms and conditions set forth herein and further certifies that all of the information contained in the Application and attachments is true and correct to the best of their information, knowledge, and belief, and further certifies that he/she is authorized to execute this Application on behalf of Applicant.

I accept the above terms.

Please Sign Below

Using a touchpad or mouse, please sign in the area below. When finished signing, please click the Save Signature.

Submit the Request

By clicking 'Submit', I/We authorize Veseris or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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