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HomeMy WebLinkAbout000169 Original ContractWAREHOUSE REQUIRED- DOCUMENTATION WHERE _T0'SENDYOUR;:APPLICATION HSBC Retail Credit (USA) Inc requires that all requested documentation be received before the application process begins Should you have any questions, please call 1- 800 220 -8594 If credit line requested is greater than $50,000 or if no personal guaranty is given, you may be required to submit your latest financial statement or most recent tax return If business entity is a tax- exempt organization, please provide tax- exempt documentation Using blue or black ink, please complete all sections of the application, including the Personal Guaranty Section if necessary, include the requested financial information, and MAIL OR FAX TO HSBC BUSINESS SOLUTIONS, P0. BOX 4160. CAROL STREAM, IL 60197 -4160 FAX 1 -800- 506 -3260 rediL :ine mugs ed Credit Line Requested B Businessiflforma Ion Business Name (Maximum 26 characters) Federal Tax ID (FEIN) Membershf i Business Physical Address City Business Phone 3Go f Billing Contact Name &A ('cones (I Business Billing Address (If different) Department Name Attention To Business Type (Select One) Sole Proprietorship Li Partnership Government Agency Non Profit" For Non Profit, Financial Statements or Personal Guaranty is required if in business less than 2 years Parent Company Address C:References' Bank Name Trade Reference 1 D. Personal Guaranty (Required for all Sole Proprietorships and Partnerships. Also required forCorporations and LLC's'in business less than'2 years) As an inducement to HSBC Retail Credit (USA) Inc to finance the purchase of goods or services by the business entity that has signed the Business Account Application, the undersigned "Guarantor unconditionally guarantees the prompt payment when due, or on demand, of the full amount of indebtedness due to HSBC Retail Credit (USA) Inc from the business entity, including all charges, expenses and fees (collectively, the "Account Guarantor authorizes HSBC Retail Credit (USA) Inc to investigate Guarantor's business and /or personal credit and to furnish information about the Account and Guarantor to credit reporting agencies and others, including HSBC Retail Credit (USA) Inc 's affiliates First Name Middle Initial Last Name Home Address (if different than business physical address) Home Phone Signature E. Purchasing Information /Authorized Users Number of Authorized User Cards Requested 1 B pc) /VOLke l 4 2 3 t crel:ri .D 4 5 Do not sign this Costco Commercial Application before you read it By signing below, you (1) submit an Application for a credit limit in the highest amount we deem appropriate, regardless of any initial sale amount, (2) authonze Costco to send HSBC Retail Credit (USA) Inc your membership information, (3) represent that you are authorized to execute the Application on behalf of the business entity, (4) represent that the business entity has authorized the execution of this Application, (5) authorize us to check credit on both the business and owners and partners, if any, (6) represent that the information provided in this Application is true and correct and understand that any false information may result in cancellation of the Account, and (7) certify that you have read, met and agree to all of the terms, conditions and disclosures which are attached Signature 6fAufiorized Rep tive sin .3•V t S %rri e eh.r Business Fax Principle Name/Title 36o) 1 117- t S09 ke&T eg Billing Contact Phone 360 )N12 y51 Business Contact E -Mail Address b c p e w C T y 4 cLT Limited Liability Company Corporation City Trade Phone Social Security State Bank Contact Trade Reference 2 Unit Number City 6 City State Zip Month/Year Business Established Parent Company Name (If applicable) City Title If additional authorized users are requested, please list on a separate sheet of paper and submit with the application. to- e r 114e(4 41.2 /Title Printed Nafne City of Port Angeles Record #000169 DBA (Doing Business As) State Zip e6f4- 9d'36 Z State Zip Checking Account Number Trade Phone Date of Birth State Zip Annual Income Date Number of Employees a3 of it Date 7022 CSTCNET -04 (12 -08) BUSINESS MEMBERSHIP is $50a year Includes a free Household Card A business license (or 3 pieces of business ID) is required to apply for membership Please include sales tax in NY, HI AZ NM UT NJ WI plus all other applicable states Fees are subject to change PRIMARY CARDHOLDER Date of Birth Jr Sr II Other Nickname Name to print an membership card) Name Suffix (optional) circle one A Household Card is available to a Primary or Add on Cardholder's spouse domestic partner, or immediate family member over the age of 18 and living at the same address Household Cardholders will be asked to present proof that they live at the same address as the Primary or Add on Cardholder Date of Birth Last Name Driver's License Number* FOR COSTCO USE ONLY: Costco Membership Mktg Campaign Code Get paid to shop; XECUTIVE MEMBERSHIP is $50 a year plus an additional $50 upgrade fee a year Includes a free Household Card Limit one Executive Membership per household or business Amount Paid Resale Permit Number #2 Buying for resale? YESXNO /7. Last ame Legal First Name Tender Type PCN BUSINESS INFORMATION C,7 0) /OrT �r it/41 Company me License Number /A r'T 4.74./rr Business Mailing Address City /State /ZIP Cod 3V E -s MI Home Mailing Address (P 0 Box required d applicable) City FREE HOUSEHOLD CARD (optional) Buying for resale? YES NO Resale/Tax Exempt Authorized YES NO $40 BUSINESS ADD CARD Buying for resale? YES NO Resale/Tax Except Authorized YES You may add Additional Cardholders to your membership for $40 each Maximum of six add -ons per primary account State Nickname (Name to print on membership card) Last Name Legal First Name Jr Sr II Othe Nickname (Name to print on membership card) Name Suff is loeonail circle one Home Mailing Address (P 0 Box required d applicable) Date of Birth E mail Address (optional) Receive special offers from Costco co Date of Birth Last Name Driver's License Number* X Signature of Costco Membership Applicant E mail Address (optional) Receive special offers from Costco com Resale Permit Number #1 State Clerk Resale/Tax Exempt Authorized YES krNO Primary Cardholder Initial I% AA -11 46571 Driver's License Number* State (Area Code) Home Phone Legal First Name MI Driver's License Number* LegaN first Name Date City Nicknamb(Name to print on membership card) State Exp Date Tobacco Resale Permit Number (see below) State Exp Date Primary Cardholder Initial 0 I Prirnaw Cardholder In State Till# a'4- Date Tor Employees Pp /L ?10- 1(17 6 1 S00 (Area Code) Business Phone Ext State Exp Date State ZIP MI Jr Sr II Other Name Suffix )optional} circle one /4-1,e (Area ome Phone USD 2 3' O n FREE HOUSEHOLD CARD (optional) Buying resale? YES NO Resale/Tax Ex pt Authorized YES NO Primary Card Ider Initial A Household Card is available to a Primary or Add on Cardholder's spouse domestic partner o mediate family member over the age of 18 and living at a same address Household Cardholders will be asked to present pro that they live at the same address as the Primary or Add on Cardholder MI Jr Sr II Other Name Suffix )optional} circle one IMPORTANT INFORMATION: Costco is continually developing new and xciting programs and services at substa ial savings for our members Li Check here if you do not want your name, postal address, e-mail address, and member ip number and status shared with care lly selected partners so they may qualify you for these erings Check here if you do not want your Household Cardholder's information shared as well Your driver's license number is not mandatory to gain membership at Costco, but if you plan t write checks at Costco, we do need yo driver's license number Read this paragraph if you purchase Tobacco Products for resale As a service to our Business Membe who purchase tobacco products for resale, a provide certain information to the tobacco manufacturers rep�sentative to process retail incentives for our Business Members The information we provide is the Business Member name, address, the brand name, andjte amount of tobacco products purchased rsuant to California law, it you are a Business Member in California and you do not want us to disclose this information on your behalf, you can notify us at any U S location, by calling 1 -800- 774 -2678 or by e- mailing us 8 customerservice©costco corn Note Completion of this application constitutes acceptance of Costco's Privileges and Conditions of Mem rship, including our privacy policies an rechoes, which are available at the membership counter or online at Costco com Please provide your Household Cardholder with this information Renewal Policy Memberships renewed within months after expiration of the current embership year will be extended for 12 months from the expiration date Memberships renewed more than 2 months after such expiration will be extended for 12 months from the renewal date All rds on the membership account will xpire at the some time as the primary membership, regardless of their activation date ci