912.764.9084
info@bullochfertilizer.com
Office: 205 West Main St
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1
Application
2
Guaranty Agreement
Full Legal Name
*
First
Middle
Last
In Business Since
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Phone
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Doing Business as:
Email
*
Billing Address
*
Address Line 1
City
--- Select state ---
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Accounts Payable Contact
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First
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Shipping Address
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Address Line 1
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
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North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County of the ship to address
Single Line Text
Tax Exempt?
*
Yes
No
If Yes, a signed Sales & Use Certificate of Exemption must be attached or emailed at the time of submission. Or Gate Card no. listed below.
Gate Card No./ Tax exempt ID
Is a Purchase Order Required?
*
Yes
No
Bulloch Fertilizer Co., Inc. utilizes a credit reporting service to process all applications for credit. You MUST provide either a Social Security Number or a Federal ID Number in order for this application to be considered.
Social Security Number/ Federal ID Number
*
If applying for an individual account
All information listed above is kept in strict confidence at our accounting office located at 205 West Main Street, Statesboro, GA.
By Signing below as applicant, you authorize Bulloch Fertilizer Co., Inc. to investigate your credit history to the extent allowed by law.
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In consideration of the extension of credit granted by BULLOCH FERTILIZER CO., INC. the undersigned does hereby unconditionally guaranty payment of whatever amount shall at any time be owing to an account of goods and materials hereafter delivered, furnished, or supplied, whether said indebtedness is in the form of a note, bills or open account. This shall be an open and continuing guaranty and shall continue in force notwithstanding any changes in the form of such indebtedness or renewals or extensions granted by the Company, without obtaining any consent thereto, and until expressly revoked by written notice from me to you and such revocation shall not in any manner affect my liability as to any indebtedness contacted for prior thereto. The undersigned Guarantor further agrees to pay all expenses including court costs, attorney's fees paid or incurred by the Company in collection of any or all amounts owed them by the Credit Applicant or in enforcing this guaranty agreement.
This guaranty shall be a continuing, absolute and unconditional guaranty and shall be enforceable by BULLOCH FERTILIZER CO., INC.
All diligence in collection or protection and all presentment, demand, protest and/or notice as to anyone or everyone, of dishonor and default and of non-payment and of the creation existence of any and all guaranteed debts and of any and all extensions of credit and indulgence hereunder, are expressly waived.
The liability of the undersigned Guarantor(s) shall by joint and several. Payment from the Guarantor of monies due and owing as a result of this guaranty agreement shall be due upon demand by BULLOCH FERTILIZER CO., INC.
Business Name (if applicable)
*
Guarantor (sign individually)
Clear Signature
Printed Name
*
Title
Date
Guarantor (sign individually)
Clear Signature
Printed Name
Title
Date
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