Application For Credit – Perigee Direct

Are you a current Perigee Direct customer? *

Yes, I’m a regular
Yes, once or twice before
Not yet
I can’t recall

Best you can recall, have you ordered with Perigee Direct before? Our standard policy for a new Net 30 accounts, is that the Net 30 applicant must have an existing relationship that spans 3 or more orders. This helps establish trust between Perigee Direct and you.

Primary Business Name *

Please include legal name.

Website / URL *

Please include your company’s website address or addresses if there are multple.

Additional Business Names (optional) *

Please include additional names that are used, like DBA, AKA or other former names of business.

Approximate Date Business Started

Please give approximate date when the business was formed.

Legal Structure *

Corporation
LLC
Partnership
Proprietorship

Federal I.D. (FEIN) *

State Tax ID

Desired Credit Line (if known)

Monthly Purchase Estimate (if known)

Billing / AP Information

Primary Billing Name *

First

Last

Title

Finance, Webmaster, CEO, etc.

Additional Billing Names (optional)

List as many people as necessary, separate with a comma

Primary Billing Email *

Additional Billing Emails (optional)

Primary Billing Phone *

Additional Billing Phones (optional)

List as many Phone numbers as necessary, separate with a comma

Billing FAX (if applicable)

Address – Billing *

Address Line 1

Address Line 2

City

State

Zip Code

Shipping Information (initial or first location)

Primary Customer Name *

First

Last

Title

Additional Customer Names (optional)

List as many people as necessary, separate with a comma

Primary Customer Email *

Please include as many billing, finance, AP emails as is applicable, separated by a comma (,)

Additional Customer Emails (optional)

List as many emails as necessary, separate with a comma

Primary Customer Phone *

Additional Customer Phones (optional)

List as many Phone numbers as necessary, separate with a comma

Address – Customer / Shipping / Reciving *

Address Line 1

Address Line 2

City

State

Zip Code

Bank and Trade References

Banking Information

Include Bank, Branch, Address, Phone, Acct Rep/Officer, Routing and Account numbers etc.

Trade References

List as many or as few as you feel is appropriate. please do not list service providers or personal references.

Relevant Officers or Line of Credit Key Stakeholders

Please list the officer names, titles, physical addresses, contact phone numbers, and contact email addresses.

Upload Additional Documents (optional)

Click or drag files to this area to upload. You can upload up to 10 files.

Upload any Prepared Fact Sheets, Credit Memos, Letters, Vendor Sheets, etc that will help.

Line of Credit Terms Agreement – READ BEFORE SIGNING *

By typing your name in the above box, as proxy for your signature, states that you understand and agree to the following: that any information furnished in this application is to obtain credit for you and your company; that the information furnished has been supplied truthfully, accurately, and voluntarily, and you therefore authorize our company and its subsidiaries (hereinafter called Seller) to investigate your credit worthiness, including direct contact with past and present creditors; that you authorize banks and other financial institutions to give information to Seller to investigate your credit worthiness, including direct contact with past and present creditors; that you authorize banks and other financial institutions to give information to Seller in connection with this transaction about your savings and checking accounts and loan accounts; and that you are authorized by your company to enter into binding agreements accordingly. If Seller establishes an account for you, your signature further states that you agree to: 1) Pay to Seller each month all resulting charges from the previous Thirty (30) days; 2) The Standard Terms and Conditions of Sale (as stated on PerigeeDirect.com, and as attached on Transaction Confirmation communications); 3) The amount of credit extended by Seller may not be the same as the amount requested, and may be from time to time, decreased or increased, and that all terms and payment terms of Seller’s credit extension to you will be in effect whether the amount is greater or lesser than the amount requested; 4) In the event you make purchases from an affiliate of the Seller, you agree that either Seller or the affiliate may bill you for such purchases, and you understand that charges billed by the affiliate of Seller shall be considered an extension of the credit established with you by Seller and that all credit terms shall be effective the same as if purchase from and billed by Seller; 5) All line-of-credit payments will be in the form of Company Check, Cash, PayPal Transfer, Google Wallet Transfer, EFT, or BitCoin. No Credit Card/Debit Card payments are accepted for line of credit payments. (and a Thirty Dollar ($30.00) charge will be made on all returned checks) 6) A service charge of Five Percent (5%) per month, or an amount commensurate with the applicable state law, will be charged on all balances remaining unpaid after Thirty (30) days from the related order shipments.