Individual Credit Application Individual Credit ApplicationName* First Last Amount Requested* Date of Birth* MM slash DD slash YYYY Social Security Number* Format as 123-45-6789Present Street Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code In City Limits Yes No Number of Years* Telephone #*Mobile Phone #Email Address* Present Employer* Employer's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer's PhoneSpouse's Name First Last Mobile Phone #:*Social Security Number Format as 123-45-6789Date of Birth MM slash DD slash YYYY Spouse's Employer Employer Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneAuthorization to Charge*(Limit 4)Bank ReferenceName of Bank* Account No.* Savings No.* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone #:*Loan Officer* First Last Name of nearest relative not living with you* First Last Relationship* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Telephone #:*Written Authorization to Release InformationFor the purpose of obtaining credit, I herby authorize the release of any information to Whit Davis Lumber Plus:Authorized Signature*Date* MM slash DD slash YYYY Title* Personal GuaranteeIn consideration of credit being extended by Whit Davis Lumber Plus to the above named applicant (“Applicant”) for merchandise to be purchased by Applicant, which is hereby acknowledged as a personal benefit to the undersigned guarantor (“Guarantor”), Guarantor personally, individually and jointly and severally guarantees to Whit Davis Lumber Plus the faithful payment, when due, of all current and future accounts of Applicant. Guarantor acknowledges that Whit Davis Lumber Plus is relying on this Guaranty in extending credit to Applicant. Guarantor hereby expressly waives all notice of acceptance of this Guaranty, notice of extension of credit to Applicant, presentment, and demand for payment on Applicant, protest and notice to Guarantor of dishonor or default by Applicant or with respect to any security held by Whit Davis Lumber Plus, extension of time of payment to Applicant, acceptance of partial payment or partial compromise, all other notices to which Guarantor might otherwise be entitled, and demand for payment under this Guaranty. The Guarantor agrees to immediately reimburse Whit Davis Lumber Plus, without demand, for all costs, maximum attorneys’ fees allowed by law and all other expenses incurred in the enforcement of this Guaranty and/or the collection of any indebtedness owed to Whit Davis Lumber Plus by Applicant. Whit Davis Lumber Plus shall have the right to enforce this Guaranty irrespective of whether or not proceedings or steps are being taken against any other party primarily, secondarily, or otherwise liable for the indebtedness. Guarantor understands this Guaranty is a guarantee of this entire account, and not a specific amount, as Guarantor understands the credit limit may be increased by Whit Davis Lumber Plus from time to time. Guarantor guarantees all debt on this account. Any revocation of this Guaranty shall be in writing and delivered to the President of Whit Davis Lumber Plus, at its principal office in Jacksonville, AR. Revocation shall not affect Guarantor’s liability for debt incurred prior to such revocation.Signature of Guarantor:*Title Date* MM slash DD slash YYYY Terms of Credit AgreementApplicant, in consideration for the extension of credit to Applicant and as an inducement to Whit Davis Lumber Plus to grant such credit, represents and warrants that all information provided is true and correct, and that no unfavorable information has been omitted from this Application. Applicant also represents and warrants that Applicant is solvent and has no pending lawsuits and/or unsatisfied judgments. Applicant authorizes the release of any information to Whit Davis Lumber Plus and specifically authorizes Whit Davis Lumber Plus to investigate any claims made therein or herein. By signing this Agreement, Applicant is indicating the desire to apply for credit from Whit Davis Lumber Plus and agrees to abide by the terms and conditions of this Agreement. Applicant agrees that the extension of credit hereunder is conditioned on the approval of Whit Davis Lumber Plus, who reserves the right to increase, modify. or terminate the credit limit in its sole discretion. Applicant understands the account balance is due and payable in full by the 10th of the following month and that any outstanding balance is subject to finance charges interest and will accrue interest at the maximum rate allowed by law. Whit Davis Lumber Plus is hereby specifically authorized to report to proper persons and/or bureaus on the performance of this Agreement in exchange for the extension of credit. Applicant waives all notices of demand, protest, extensions, and default and hereby agrees, without demand, to immediately reimburse Whit Davis Lumber Plus for all costs, attorneys’ fees, and other expenses incurred in the enforcement of this Agreement and/or the collection of any indebtedness of Applicant owed to Whit Davis Lumber Plus. This Agreement is governed by the laws of the state of Arkansas.Applicant Signature*Job Title Date* MM slash DD slash YYYY For Office Use OnlyDate Received Date Processed Approved by Date Approved Credit Limit Salesman Acct. # Acct. Type Rating Terms PhoneThis field is for validation purposes and should be left unchanged. 19563 HOW CAN WE HELP YOU? 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