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Print, fill out and email to sales@enting.com or fax back to 937-294-5485. Thank you.

Business Name __________________________________________
Street __________________________________________________
City and State ____________________________Zip_____________
Type of Business ___________________________
Telephone _______-_______-_____________
Fax Number _______-_______-_____________
Type of Company (circle): Corporation Partnership Proprietorship L.L.C.
No.of Employees ___ Sales Volume Last Year $__________ Year Business was Established ______ State of Incorporation ______
Has your firm or any of its principal officers ever declared bankruptcy? Yes No
Does your business qualify for Sales Tax Exemption? Yes No (Ohio businesses must include exemption certificate with application)
Your Federal I.D. #___________________________________ Dun & Bradstreet #______________________________________
Do you require Purchase Order numbers on invoices? Yes No Amount of Credit desired $______________________________
Contact Person about this Account (name) _______________________________________ Title__________________________
Principal Owner(s) or Officers
Name _____________________________ Title_________________ Social Security No. ____-____-______ Years in Business ____
Home Address ______________________________________________ City _________________ State _____Zip ____________
Home Phone _______-_______-_____________
Name _____________________________ Title _________________ Social Security No. ____-____-______ Years in Business ____
Home Address _________________________________ City ______________________________ State _____ Zip _____________
Home Phone _______-_______-_____________ Bank Reference Name of Your Bank_______________________________________ Bank Officer______________________________________
Address _________________________________________ City __________________________ State _____ Zip ____________
Phone _____-_____-________ Fax _____-_____-________Bank Account Number ____________________
Trade References from which you buy regulary
Name ______________________________________________
Address _____________________________________________
City _______________________ State _____Zip ____________
Telephone ____-____-_______ Fax _____-____-________
Name ______________________________________________
Address _____________________________________________
City _______________________ State _____ Zip ____________
Telephone ____-____-_______ Fax _____-____-________
Name ______________________________________________
Address _____________________________________________
City _______________________ State _____ Zip ____________
Telephone ____-____-_______ Fax _____-____-________
Name ______________________________________________
Address _____________________________________________
City _______________________ State _____ Zip ____________
Telephone ____-____-_______ Fax _____-____-________

Terms: I/we (jointly and severally, if more than one) hereby certify that the statements in this application for open account credit are true and complete to the best of my/our knowledge and I am/we are authorized to submit this application and consent to the use of all credit card numbers, phone numbers and social security numbers by Enting. I/we also authorize Enting Water Conditioning, Inc. to perform an investigation of my/our or the company’s credit worthiness and to contact all references identified in this application. By my/our signsture(s) below, I/we hereby agree to pay all bills when same become due or payable pursuant to the terms of sale. I/We further agree to pay all interest charges, not to exceed 1 & 1/2% per month, on past due balances, if applicable, and all collection costs plus reasonable attorney’s fees in the event action is commenced against me/us for non-payment. In agreeing to open this account, the provisions hereof, and all disputes arising hereunder, shall be controlled by, and construed under the laws of Ohio. Any legal or equitable action brought by the customer or Enting Water Conditioning, Inc. as a result of this transaction must be filed and litigated in either the Common Pleas Court of Montgomery County, Ohio, or the Municipal Court of the City of Dayton, Ohio, to which Courts the customer expressly asserts and consents to personal jurisdiction.
Incomplete information or lack of signatures will delay approval.

Print Name of Officer __________________________________
Officer’s Signature ____________________________________
Title _____________________________ Date ______________
If Indvidual Proprietorship or Partnership:
Signature _________________________ Date ______________
Signature _________________________ Date ______________

Contact Person for Web Orders: (name) ___________________________________Email address___________________________
Personal Guarantee
By signing the Application, I acknowledge that I have personally guaranteed the debts and obligations of my business and agree that I am personally obligated to perform all the terms of and make all the payments to Enting Water Conditioning Inc. required by the agreement, of which this Application as part.

Signature _____________________________________________________________

Signature _____________________________________________________________