Net 30 Request

DRIPLOC is happy to announce that we are now accepting applications to set up open accounts.

Please complete the form in its entirety. Allow 2-3 days for processing.

Questions? Please call 877-374-7562

Net 30 Day Application

Customer Information

Company Name(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Business Type(Required)

Corporation

Partnership

Proprietorship

Public

Private

Other

Assigned Point of Contact(Required)

First Last

Title(Required)

Email(Required)

Direct Phone(Required)

Days/Frequency Invoices are Paid(Required)

Names and Addresses of Owners, Partners, or Officers

Owner, Partner or Officer #1

Name

First Last

Title

Address

Street Address Address Line 2 City State ZIP Code

Owner, Partner or Officer #2

Name

First Last

Title

Address

Street Address Address Line 2 City State ZIP Code

Owner, Partner or Officer #3

Name

First Last

Title

Address

Street Address Address Line 2 City State ZIP Code

Credit Account Information

Credit Limit Requested(Required)

Type of Account Paying with:(Required)

Checking

Credit Card

Bank References

Reference #1

Bank Name(Required)

Account

Phone(Required)

Fax(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Reference #2

Bank Name(Required)

Account

Phone(Required)

Fax(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Trade Credit References

Trade Credit Reference #1

Vendor Name(Required)

Contact Name(Required)

First Last

Phone(Required)

Fax

Address(Required)

Street Address Address Line 2 City State ZIP Code

Account Number(Required)

Account Limit(Required)

Number of Years(Required)

Trade Credit Reference #2

Vendor Name(Required)

Contact Name(Required)

First Last

Phone(Required)

Fax

Address(Required)

Street Address Address Line 2 City State ZIP Code

Account Number(Required)

Account Limit(Required)

Number of Years(Required)

Trade Credit Reference #3

Vendor Name(Required)

Contact Name(Required)

First Last

Phone(Required)

Fax

Address(Required)

Street Address Address Line 2 City State ZIP Code

Account Number(Required)

Account Limit(Required)

Number of Years(Required)

Terms & Agreement

Consent(Required)

I agree to the Credit Terms

CREDIT TERMS
• Payment on all invoices due within 30 days of invoice date
• All overdue invoices bear interest at 2% per 30 days on any unpaid balance
• All term invoices not paid via check or ACH payment will be subject to a 3% processing fee
• Credit applicant agrees to pay all costs of collection, including collection agency fees, court costs and attorney and legal fees incurred pursuing a delinquent balance
• Credit terms and limit may be cancelled or changed by Creditor at any time without notice
• All transactions are governed by the laws of the Creditor’s state
• All transactions are governed by the terms of the Creditor’s documents

I/We certify that the above information is true and correct, and I/We agree to pay this account in accordance with your credit terms. I/We authorize you to verify this information and/or obtain additional information by securing data from a
credit reporting agency. I/We understand that all past due balances will be subject to a 2% per 30 day late payment fee. I/We further agree to pay collections charge and/or reasonable attorney’s fees, costs, in the event of default, if the account is placed with an attorney or bonded collection agency. I/WE HEREBY AUTHORIZE MY BANK, LENDER OR FINANCIAL INSTITUTION AND/OR ANY TRADE REFERENCE TO RELEASE INFORMATION REGARDING MY ACCOUNT TO DRIPLOC LLC.

THE TERMS OF THIS AGREEMENT INCLUDE ALL TERMS SET FORTH ON THIS PRINTED PAGE AND PURCHASER AND GUARANTOR AGREE TO BE BOUND BY ALL SUCH TERMS BY SIGNING HEREINBELOW.

(Pursuant to the terms of Personal Guarantee set forth in this agreement)

PERSONAL GUARANTEE: In consideration for the credit extended to the above listed Purchaser, for good and valuable consideration, the undersigned hereby guarantees and agrees to be unconditionally and personally liable to DRIPLOC LLC, its successors, assignees, parents, and subsidiaries, for the due performance of each of the past, present, and future Secured Obligations and/or indebtedness incurred by the above Purchaser, its successors, assignees, parent and/or subsidiaries to DRIPLOC LLC.

1. I/We hereby waive notice of acceptance hereof, and of all notices of any kind to which I/we may be entitled, including without limitation any and all demands of payment, notices of non-payment, protest, and dishonor to me or said business entity. I/My liability hereunder is direct and unconditional and may be enforced without requiring DRIPLOC LLC to first resort to any other right, remedy or security. In the event of default in payment by Purchaser, I/We shall be obligated to pay to DRIPLOC LLC, all of the Secured Obligations plus 1 ½% per month on all past due balances, 30% collection charge and/or reasonable attorney’s fees and costs
2. I/We hereby waive any and all right to a trial by jury in any action or proceeding based hereon. This instrument cannot be changed orally and shall be interpreted according to the laws of the State of Oklahoma

Signature(Required)

Name(Required)

First Last

Title(Required)

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