BUSINESS CREDIT APPLICATION


If Applicant is not a natural person but instead a legal identity, please click here to be directed to the form for legal identities. 

 

APPLICANT INFORMATION:

    1. NAME(S) AND ADDRESSES OF APPLICANT(S) IF NATURAL PERSONS: 
       
    2. NAME AND ADDRESS OF PRINCIPAL OFFICE OF APPLICANT (IF APPLICANT IS NOT A NATURAL PERSON): 
       
    3. NAMES, ADDRESSES AND TITLES OF OWNERS (IF APPLICANT IS NOT A NATURAL PERSON): 
       
    4. TYPE OF BUSINESS OF APPLICANT IF NOT A NATURAL PERSON: 
      (e.g. Partnership, Corporation, LLC, LP, LLP, PA, etc.): 
       
    5. ASSUMED NAMES USED BY APPLICANT, IF ANY: 
       

    6. BILLING ADDRESS FOR APPLICANT: 
       

    7. APPLICANT’S TELEPHONE NUMBER(S):
    8. APPLICANT’S FACSIMILE NUMBER(S):

APPLICATION AGREEMENT

     In consideration of credit hereby, heretofore and/or hereinafter extended to Applicant by Tomeldon Co., Inc. d/b/a Pharmacy Solutions (“Pharmacy Solutions”) for goods/products sold by Pharmacy Solutions on account to Applicant, Applicant declares that all information provided by Applicant to Pharmacy Solutions is true and correct, then no material information has been omitted, attests to the Applicant’s financial solvency and agrees to pay all obligations as they become due. Applicant understands payment terms to be 21 days from receipts of goods. Applicant agrees that credit extension is at the sole discretion of pharmacy Solutions and may be withdrawn by Pharmacy Solutions at any time. If Applicant not a natural person, the signatory below represents that he/she has authority to execute this Agreement on behalf of the said entity. Applicant authorizes Pharmacy Solutions to make inquiries and investigation, as it deems necessary for credit purposes.

     Applicant agrees that all purchases made and credits extended are subject to the following TERMS and CONDITIONS:

  1. All new accounts will be paid for COD until credit approval.
  2. All invoices are due and payable in full within 21 days. Payments shall be made at the office of Pharmacy Solutions at 1921 W. Pioneer Pkwy. Arlington, Texas 76013.
  3. Remittance for an NSF check will be by cash or cashier’s check only. NSF checks or late payments will, at the option of Pharmacy Solutions, will result in a COD status being placed on the account or discontinuance of the account, in addition to any other rights or remedies available to Pharmacy Solutions at law or in equity. In the event of an NSF check, Applicant shall reimburse Pharmacy Solutions for any NSF charges that it incurs as a result.
  4. The goods/products/services purchased from Pharmacy Solutions are payable in full as stated in applicable invoices.
  5. The applicant will notify Pharmacy Solutions within 10 days of any changes of the change of address on the Applicant.
  6. Exclusive venue for any claims brought under this Agreement shall lie in Tarrant County, Texas.

Agreed on 

Name of signer:       

 

 

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Pharmacy Solutions https://rxcompound.com
Signature Certificate
Document name: BUSINESS CREDIT APPLICATION
Unique Document ID: c2f1eebbea276aaa91dfdf12a2c0ea544c22d021
Timestamp Audit
November 3, 2017 12:38 pm CDTBUSINESS CREDIT APPLICATION Uploaded by Kim Siegenthaler - Kim@rxcompound.com IP 66.169.162.236
December 20, 2017 10:30 am CDTKim Siegenthaler - kim@rxcompound.com added by Kim Siegenthaler - Kim@rxcompound.com as a CC'd Recipient Ip: 66.169.162.236