A&R Floor Covering Accessories and Supplies, Inc.
Credit Application and Agreement
(Fill out completely-Print or Type)
Attach Financial Statements
23011 Moulton Pkwy, C-5, Laguna Hills, CA 92653 P: (949) 768-6222 F: (949) 768-4340
4324 E La Palma Ave, Anaheim, CA 92807 P: (714) 572-8370 F: (714) 572-8492
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Firm Name______________________________________________________________ Date_____________________________
Phone# ( ) ________________________ Fax# ( )___________________________ Email____________________________
Street__________________________________________ City_______________________ State___________ Zip___________
__________________________________________ _____________________________ ( )___________________________
Accounts payable address (If different from above) Accounts payable contact Accounts Payable phone #
Year Est._______________ Credit Requested______________________ Fed I.D.#/Soc. Sec.#___________________________
Corporation ( ) Partnership ( ) Limited Partnership ( ) Proprietorship ( )
Drivers License#____________________________________ Contractors License#__________________________________
Is this account a resale account? Yes No Resale#______________________________________________________
Please supply a copy of your signed resale certificate with this application.
_____________________________________ ___________________________ ( )_______________ __________
Full name of owner(s)/authorized officer(s) Home address Phone # Soc. Sec. #
_____________________________________ ___________________________ ( )_______________ __________
Full name of owner(s)/authorized officer(s) Home address Phone # Soc. Sec. #
____________________________ _________ _________________________________ Type of Visa M/C
Security Credit Card # [Link] Cardholder’s Name Card: Amex Disc
Does your firm use purchase orders? Yes No Authorized Agents ____________________________________________
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Suppliers/Factors Address Phone
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
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Name of Bank_____________________________________ Type of Acct.________________ Acct#____________________
Address______________________________________________________________ Phone# ( )_____________________
Credit Application & Security Agreement
I/We the undersigned (hereinafter called “Applicant” or “Debtor”) hereby apply for the regular open account with A&R Floor Covering
Accessories & Supplies, Inc., (herein after called “Seller” or “Secured Party”) whose main business address is 23011 Moulton
Parkway, Suite C-5 Laguna Hills, CA 92653. In consideration of seller making available to me/us a Net 10th charge account and a
line up to $5,000.00, I/we jointly and severally agree as follows:
1. Applicant represents and warrants that all information contained in this application, or appended hereto, is true and complete. I/
we understand that credit may extended in reliance upon the statement made in or figures supplied with this application, or upon
statements or financial information which may from time to time be furnished to Seller. This account is a commercial account not a
retail credit account, and no purchase hereunder will be a retail installment sale as defined by the Laws of California.
2. I/we understand that terms of sales are Net 30, unless otherwise indicated on invoice, and invoices a past due thereafter. I/we
agree to pay a time price differential or carrying charge of 1.5% per month or such % as may hereinafter be designated by Seller, on
all past due invoices.
3. In the event Seller institutes legal proceedings to collect any indebtness, which may be in default; or if Seller deems it necessary
to retain council, refer to a collection service or undergo any other costs or expenses in an effort to collect a balance which is in
default, I/we the undersigned, agree to indemnify Seller for all reasonable costs incurred by Seller, including, but not limited to,
attorney’s fees, court costs, collection fees, filing fees, etc..
4. I/we understand that in signing this agreement and application, we sign in both our capacity as Corporate Officers and also jointly
and severally as personal guarantors for the total amount of all obligations now existing and arising out of future purchases to be
made from the Seller. I/we further agree that as and when any indebtness to applicant falls due, action may be brought by Seller
against me/us as if I/we were the purchasers in the sale creating the debt; nor need Seller initiate any remedy proceeding against
the name Applicant before proceeding against me/us as guarantors.
5. The undersigned debtor does hereby grant to “The Secured Party” a continuing security interest in all and to all present and future
accounts receivable to Debtor (hereinafter called Accounts), and in to all returned or repossessed goods the sale or lease of which
shall have given rise to any such accounts (the accounts, goods and proceeds being hereinafter collectively called “The Collateral”).
The Collateral shall secure payment of all liabilities and debts of Debtor to Secured Party or Debtor.
Concurrently with the execution hereof, Debtor shall cause to be executed and delivered to Secured Party a financing statement in
the form of the financing statement attached hereto and made a part hereof, the cost of recording such financing statement in such
jurisdiction as Secured Party may require, including recording costs and documentary stamps as may be required, to be borne and
paid by the Debtor. The Debtor hereby represents and warrants that it has good and marketable title to the collateral, free and clear
of any liens, claims or encumbrances. Debtor agrees that it will not sell, assign, transfer, or otherwise dispose of the collateral, or
any interest therein, nor grant any other security interest in the collateral, not otherwise do or permit anything to be done or occur
that may impair the collateral as security hereunder. Until notice of the contrary is given by the Secured Party, Debtor will collect
the amounts for the Secured Party at Debtors own expense. Debtor will immediately upon receipt thereof deliver in kind to Secured
Party all cash, checks, and other proceeds of the collateral duly endorsed in favor of Secured Party. Secured Party may at any time
and from time to time notify any account debtor of the existence of this Security Agreement, and direct such account debtor to pay
directly to Secured Party the amounts due or to become due from such account debtor. Secured Party may at Debtor’s expense,
and either in Debtor name or it’s own, enforce collection of any and all accounts be suit or otherwise, and surrender, release, or
exchange all or any part thereof, or comprise or extend or renew for any period, and indebtedness thereunder. Secured Party is
hereby authorized to endorse in the name of comprise or extend or renew for any period, any indebtedness thereunder. Secured
Party is hereby authorized to endorse in the name of Debtor, any item whatsoever received by Secured Party representing proceeds
of any of the collateral.
Debtor shall furnish to Secured Party such reports and other information concerning the collateral, and such copies of its invoices
evidencing the accounts as the secured party may request. Debtor shall permit Secured Party or its representatives at any time to
inspect Debtor’s books and records pertaining to the collateral. In the event of the default of Debtor in the payment of any debt due
to Secured Party, or in the event of a default or breach of terms of the conditions of this Security Agreement, or upon the death,
dissolution, termination of existence, insolvency, bankruptcy, appointment of a receiver, assignment for benefit of creditors or
commencement of any proceeding under any bankruptcy law or insolvency laws by or against the Debtor, all obligations of Debtor
to Secured Party shall at Secured Party’s option become immediately due and payable, and Secured Party may exercise any rights
and remedies available to it under the Uniform Commercial Code of California.
6. I/we authorize any bank or banks at which I/we maintain accounts, to furnish A&R Floor Covering Accessories & Supplies, Inc.
7. Seller, Applicant, Signators, and all other parties to this agreement hereby waive any objection to the venue of any action
which may be filled in Municipal Court of Orange County, South Orange County Judicial District, or the Superior Court of Orange
County by virtue of this agreement. This agreement shall be governed by and construed in accordance with the laws of the state of
California and I/we hereby consent to the jurisdiction of the California Courts. Seller, Applicant, Signators and all other parties to this
agreement hereby waive trial by jury in any action or proceeding brought on, under or by virtue of the Agreement and Application.
8. Seller may at its sole discertion, grant or refuse to grant, or impose limitations upon future extension of credit.
9. This agreement shall be binding upon the applicant, all signatories, guarantors, their heirs, administrators, executors, successors,
personal representatives and assigns and shall inure to the benefit of Secured Party, its heirs, successors, personal representatives
and assigns.
Date__________________________________________ Name of Firm _________________________________________
Signature ______________________________________________________________
