Credit Application

Step 1 of 6

General Information
If you can not complete the mandatory fields please place n/a into the text box.
MSD Contact*
Applicant Name*
Email*
Phone*
Credit Line Desired*
Company is a*
- Corporation
- Partnership
- Proprietorship
- L.L.C.
- P.L.C.
Corporate Registration Number*
Tax Exempt?*
- Yes
- No
If yes - attach a Tax Exempt Certificate at the end of the form
Tax ID Number*
Annual Sales*
Years in Business*
Please enter a number greater than or equal to 1.
State of Incorporation*
Accounts Payable Contact*
First Last
Accounts Payable Email*
Accounts Payable Phone*

List Of Offices
Company Directors/Officers/Principal
If you can not complete the mandatory fields please place n/a into the text box.
Name 1*
First Last
Title*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Name 2
First Last
Title
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone
Name 3
First Last
Title
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone

Banking Reference
If you can not complete the mandatory fields please place n/a into the text box.
Bank Name*
Account Number*
Bank Contact Name*
Branch Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*

Trade References
If you can not complete the mandatory fields please place n/a into the text box.
Vendor 1
Vendor 1*
Vendor Contact Name*
Payment Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Account Number*
Highest Credit Limit*
Years Associated*
Vendor 2
Vendor 2*
Vendor Contact Name*
Payment Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Account Number*
Highest Credit Limit*
Years Associated*
Vendor 3
Vendor 3
Vendor Contact Name
Payment Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Highest Credit Limit
Years Associated

Financial Information
If you can not complete the mandatory fields please place n/a into the text box.
Attach current Federal Form W-9 (Rev, October 2018)*
- If credit requested is above our standard limits you may be asked to provide the most current financial statements and most current year end financials. (Balance Sheet, Income Statement, Statement of Cash Flow) - This form must be completed entirely; no other form will be accepted. Attachments will be accepted as long as the credit application is complete. - No work will be done until credit application is completed, approved and the customer is notified.
Upload Tax Exempt Certificate*
Other Relevant Files

Terms and Conditions Agreement
If you can not complete the mandatory fields please place n/a into the text box.
Name*
First Middle Last
Date*
Date Format: MM slash DD slash YYYY
CAPTCHA
Authorization*
Debtor acknowledges and accepts without reservation the financial responsibility, authority, ability and willingness to pay in accordance with the terms and conditions set forth below.
In consideration of the extension of credit by Mechanical Systems of Dayton, Inc. (Creditor) to you, (“you” or the “Debtor”), you agree to the following:
Credit Terms: All invoices are due net Thirty (30) days from the date of invoice. Past due invoices may incur finance charges at the rate of 1.5% per month,
18% per annum. Discount terms, if applicable, arestrictly enforced. Sixty (60) day past due accounts will automatically become C.O.D. A minimum charge
of $50.00 will be added to any dishonored check orinstrument, in addition to any other interest charges.
You agree to pay the reasonable attorney’s fees and other expenses incurred by the Creditor in collecting any amounts due hereunder, in addition to all
other amounts owed. Any suit between the parties shall be governed by the laws of the State of Ohio and shall be brought exclusively in the courts of the
Ohio County from which the material was shipped or purchased. If the suit involves materials shipped from multiple Ohio counties, suit may be brought in
any one of the said counties. The undersigned applicant further consents to both personal jurisdiction and venue in said court. The undersigned applicant
also waives the right to demand a jury in any action between the parties to this agreement.

Guarantor: The undersigned guarantees payment of all past, present and future indebtedness in addition to all intress, expenses and reasonablecost of
collection, reasonable attorney's fees or other obligations due in connection with such indebtedness of Debtor to Creditor.
Termination: You acknowledge the right of the Creditor to refuse to extend you additional credit at any time, in the Creditor’s sole discretion and without
prior notice.
Change of Status: The Debtor understands that it must notify the Creditor in writing of any change of ownership, the name of or the structure or nature of
the Debtor’s business, or the merger, sale, acquisition or dissolution of the Debtor.
The Debtor represents and warrants that all statements contained in this Customer Terms and Conditions are true and correct and grants permission for the
Creditor to contact any customer or creditor of the Debtor and for such customer or creditor to furnish to the Creditor any and all information which may
be requested in consideration of credit. This consent shall survive throughout the entire term that the Debtor purchases material from the Creditor. The
Debtor releases and holds Mechanical Systems of Dayton, Inc. or any or all of its Subsidiaries harmless from liability for obtaining and using this information.
The Debtor authorizes the Creditor to release its credit information to other suppliers, as required. The Creditor will consider this as a continuing statement
of the Debtor’s financial position and situation until notified otherwise by the Debtor. All representation and warranties shall be deemed repeated and
reaffirmed as true and correct by the Debtor at the time of each purchase.
Security: In order to secure the extension of credit under this Agreement and any and all other sums, amounts and/or obligations due and owing from the
Debtor to the Creditor (collectively, “Obligations”), the Debtor agrees to have the Personal Guaranty set forth below signed by a principal of the Debtor and
delivered to the Creditor upon delivery of this Agreement and the Credit Application.
Miscellaneous: The agreement between the Creditor and the Debtor and Guarantor(s) relating to the extension of credit by the Creditor shall be governed
by Ohio law and constitutes the entire agreement between the parties with respect to its subject matter, and supersedes all prior oral or written
agreements, and can only be modified with the written consent of all parties. To the extent any portion of this Agreement is invalid or contrary to any
existing or future law, such portion is deemed severed from the Agreement and the balance of the Agreement is not affected and remains in full force and
effect. The undersigned represents and warrants that he/she has all the requisite power and authority to sign on behalf of the Debtor and that this is the
legally binding obligation of the Debtor, enforceable in accordance with its terms. Applications submitted via facsimile, scan, email or other electronic
means are considered original

Credit Application

Step 1 of 6

General Information

List Of Offices

Company Directors/Officers/Principal

Banking Reference

Trade References

Vendor 1

Vendor 2

Vendor 3

Financial Information

Terms and Conditions Agreement