Sims HD - Application for Credit

Customer Name )Individual or Company)*

Email

(d/b/a) Trade Name

Parent Company Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Business Information

Type of Business*

D & B #

Have you ever filed bankruptcy?*

Yes
No

What year did you file?

FEDERAL Tax ID

How long have you been in business?*

Less than 2 years
Over 2 years

How many years in total?

INDIVIDUAL PERSONAL GUARANTY

The undersigned guarantor(s), for and in consideration of SHD extending credit at my/our request to the Customer named above, in which I/we have a financial interest, jointly, severally and unconditionally personally guarantee prompt payment and performance of any obligations Customer to SHD whether now existing or hereinafter made, and further agree to bind myself/ourselves to pay on demand any sum which is due by Customer to SHD whenever Customer fails to pay the same. It is understood that this guaranty shall be absolute, continuing and irrevocable for such indebtedness of Customer. I/We expressly waive presentment, demand, protest, my/our homestead exemption as to this debt, notice of protest, dishonor, diligence, maturity, default or nonpayment, acceptance of this guaranty, extending of any guaranteed indebtedness already or hereafter contracted for by Customer, any modifications or renewals of any credit agreement evidencing the indebtedness hereby guaranteed and all setoffs and counterclaims. If collection of amounts due requires the assistance of a collection agency or attorneys, suit is brought hereon, or it is enforced through any judicial proceeding whatsoever, I/We agree (a) that SHD reserves the right to bring legal action in whatever jurisdiction SHD deems necessary, whose laws, at the option of SHD, shall govern this Agreement, and (b) to pay all costs and expenses of collection, including reasonable attorney’s fees not exceeding a sum equal to fifteen percent (15%) of the outstanding balance owing, plus all other reasonable expenses incurred by SHD in exercising any of SHD’s rights and remedies. The Undersigned recognizes the obligation of the Applicant and the undersigned and agrees to hold the portion of all payments received by Applicant which include payment to Applicant for the rent and/or purchase of equipment and supplies furnished by SHD pursuant to this agreement to be held in a separate trust account for payment to SHD. The undersigned agrees to act as fiduciary for payment to SHD and agrees that Applicant shall not use said payments for any other purpose, in exchange for the Applicant’s ability to rent and/or purchase equipment and supplies on a credit account. The undersigned agrees that any failure to hold payments in trust for SHD shall create a debt which is not dischargeable in bankruptcy and which shall be an exception to discharge pursuant to the terms of 11 USC 523 (a)(4) and (6). The undersigned represent that (i) the information contained in this Agreement is a true and correct statement of the financial condition of Customer; and (ii) a photo or facsimile copy of this Agreement shall be valid as the original. If any part of this Agreement is held unenforceable, the remainder of this Agreement shall not be affected thereby. The undersigned hereby waives the right to a jury trial of any or all claims or disputes which may arise from this Agreement. SHD shall not be required to exhaust all remedies against Customer prior to exercising its rights against Guarantor(s). I/We authorize SHD to make whatever credit inquiries it deems necessary in connection with this Agreement. Bank and trade reference(s) can accept this authorization to disclose to SHD and/or their respective designees (and any assignee or potential assignee thereof), Guarantor(s) information normally released to a prospective creditor including: length of time account has been active, average monthly balances, how the account has been handled, and details of any lending relationship. This application and the agreement, contained herein may be delivered through the use of electronic means, including pdf, email and/or facsimile. Delivery of an electronic version shall be deemed to be delivery of an original.

Agree to Terms & Conditions Stated Above

Guarantor's Signature*

Guarantor's Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SSN*

Witness Signature

Print Witness Name

Date

Signatory Information (Authorized Agent)

Name

Title / Relationship to Customer

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Social Security Number

Email

Bank Information

Bank Name

Contact Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Checking Account Number

Loan Account Number

Accounting Information

Is a Purchase Order Required?

Purchase Order Number #

Job Number #

Tax Exempt

Yes
No

Upload Tax Exempt Forms

Max. file size: 3 GB.

Accounts Payable (A/P) Contact

A/P E-Mail Address

A/P Phone Number

Trade References

A/P Fax Number

Reference #1 Name

Reference #1 City/State

Reference #1 Phone

Would you like to add more references?

Yes
No

Reference #2 Name

Reference #2 City/State

Reference #2 Phone

Reference #3 Name

Reference #3 City/State

Reference #3 Phone

Terms & Agreement

TERMS & AGREEMENT

The undersigned (“Customer”) in consideration of Sims HD LLC. or any of its subsidiaries and affiliated entities, successors or assigns (“SHD”) extending commercial credit based upon the information furnished herein, warrants and agrees that by executing this Agreement: (a) all purchases/rentals made by Customer from SHD are subject to the terms and conditions contained herein; (b) Customer has received, read, understands and accepts all of the terms and conditions of SHD Rental contract, which are on the reverse side of each and every rental contract and available in writing, upon request, including the release, indemnification and insurance provisions; (c) the Rental Contract terms are deemed incorporated into and made a part of this Agreement and each and every rental/sale of equipment and/or provision of labor furnished to Customer, whether or not Customer executes each Rental Contract; and (d) any terms in the Customer’s acceptance, purchase order or other documentation that are inconsistent with or in addition to this Agreement (except such additional terms which are required by law) shall be void and of no effect (any use or reference to Customer’s purchase order or purchase order number in any Rental Contract is for Customer’s convenience only). SHD shall deliver equipment in consideration for Customer’s agreement to be bound by the Rental Contract. In making this Agreement upon which SHD will rely to extend commercial credit, I/We agree to SHD terms of payment as follows: NET DUE 30 days of RECEIPT on all accounts and service charges of 1.5% per month on all invoices/contracts not paid when due or the maximum rate permitted by law, whichever is less. Any disputed invoices must be brought to the attention of SHD within fifteen (15) days of the receipt or the invoices/contracts are deemed correct and undisputed. At SHD discretion, any account with a delinquent balance may be placed on a cash basis, deposits may be required and the rental equipment picked up without notice. If collection of amounts due requires the assistance of a collection agency or attorneys, suit is brought hereon, or it is enforced through any judicial proceeding whatsoever, I/We agree (a) that SHD reserves the right to bring legal action in Hillsborough County jurisdiction, State of Florida, shall govern this Agreement, and (b) to pay all costs and expenses of collection, including but not limited to, reasonable attorney’s fees, plus all other reasonable expenses incurred by SHD in exercising any of SHD’s rights and remedies. The individual executing this Agreement below warrants that (i) s/he is authorized to do so; (ii) the information contained in this Agreement is a true and correct statement of the financial condition of Customer; and (iii) a photo or facsimile copy of this Agreement shall be valid as the original. If any part of this Agreement is held unenforceable, the remainder of this Agreement shall not be affected thereby. Customer waives the right to a jury trial of any or all claims or disputes which may arise from this Agreement. I/We authorize SHD to make whatever credit inquiries it deems necessary in connection with this Agreement. Bank and trade reference(s) can accept this authorization to disclose to SHD and/or their respective designees (and any assignee or potential assignee thereof), Customer information normally released to a prospective creditor including: length of time account has been active, average monthly balances, how the account has been handled, and details of any lending relationship. I/We authorize SHD to contact our insurance company and authorize the insurance company to issue insurance certificate(s) when SHD’s calls from time to time showing the insurance required in the Rental Contract to be maintained by Customer. This application and the agreement, contained herein may be delivered through the use of electronic means, including pdf, email and/or facsimile. Delivery of an electronic version shall be deemed to be delivery of an original.

Agree to Terms & Conditions Stated Above

Customer Name*

Authorized Officer's Name

Authorized Officer's Signature*

Authorized Officer's Title

Date*