cus.bectran.com
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161.47.116.204
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Submitted URL: https://cus.bectran.com/customer/EReqProc?rid=sx6wOs9EzsrN4Ddj4Qpn_bqmaPKvUK02539362LCGFTFtXz6.iDAyOuI4CvGYZmseReND
Effective URL: https://cus.bectran.com/customer/outofnet/onetRequest.jsf?linkCode=sx6wOs9EzsrN4Ddj4Qpn_bqmaPKvUK02539362LCGFTFtXz6.iDAy...
Submission: On June 10 via manual from US — Scanned from US
Effective URL: https://cus.bectran.com/customer/outofnet/onetRequest.jsf?linkCode=sx6wOs9EzsrN4Ddj4Qpn_bqmaPKvUK02539362LCGFTFtXz6.iDAy...
Submission: On June 10 via manual from US — Scanned from US
Form analysis 2 forms found in the DOM
Name: PERSGTY_FORM — POST /customer/outofnet/onetRequest.jsf?dswid=7266&cid=1
<form id="PERSGTY_FORM" name="PERSGTY_FORM" method="post" action="/customer/outofnet/onetRequest.jsf?dswid=7266&cid=1" class="form" enctype="application/x-www-form-urlencoded">
<div class="card">
<div class="card-header">
<h5 class="card-title"><label>Electronic Credit Reference Request</label>
</h5>
</div>
<div class="card-body bg-light-grey">
<div id="PERSGTY_FORM:j_id_5w" class="ui-panel ui-widget ui-widget-content ui-corner-all actionBar" style="height:30px" data-widget="widget_PERSGTY_FORM_j_id_5w">
<div id="PERSGTY_FORM:j_id_5w_content" class="ui-panel-content ui-widget-content"><button id="PERSGTY_FORM:j_id_5x" name="PERSGTY_FORM:j_id_5x" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-left backButtonTop"
aria-label="" onclick="" style="background-color: #FFFFAC" type="submit"><span class="ui-button-icon-left ui-icon ui-c ui-icon-circle-triangle-e"></span><span class="ui-button-text ui-c">Click here to provide credit
reference</span></button></div>
</div>
<div id="PERSGTY_FORM:j_id_5y" class="ui-messages ui-widget" aria-live="polite"></div>
<div id="PERSGTY_FORM:erefLetter" class="ui-panel ui-widget ui-widget-content ui-corner-all noborder" data-widget="widget_PERSGTY_FORM_erefLetter">
<div id="PERSGTY_FORM:erefLetter_content" class="ui-panel-content ui-widget-content">
<div class="card mb-0">
<div class="card-body">
<div class="row">
<div class="col-md-4"><img id="PERSGTY_FORM:j_id_64"
src="data:image/png;base64,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"
alt="" class="cust_imgs">
</div>
<div class="col-md-4 ml-auto"><span style="color: #3366cc; font-family: Arial; font-weight: bold; font-size: 13.5pt;">Electronic Credit Reference Request </span>
<br><span class="label_13x">Core-Mark US, LLC.</span>
<br><span class="text_11x">1500 Solana Blvd.</span><img id="PERSGTY_FORM:j_id_6i" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">Suite
3400</span>
<br><span class="text_11x">Westlake</span>,<img id="PERSGTY_FORM:j_id_6n" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">TX</span><img
id="PERSGTY_FORM:j_id_6p" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">76262</span>,<img id="PERSGTY_FORM:j_id_6s" width="5" height="1"
alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">US</span>
</div>
</div>
</div>
</div>
<table>
<tbody>
<tr>
<td><span class="highlightLabel">Date of Request :</span><span class="text_12x">Jun 7, 2024</span><img id="PERSGTY_FORM:j_id_8m" width="5" height="1" alt=""
src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_12x">- Re: Credit Application - </span><span class="custom-label bg-dark">REQ02487084</span></td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td></td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td><span class="text_12xnp">HEARTLAND BANK</span>
<br><span class="text_12xnp">421 HILL RD</span><img id="PERSGTY_FORM:j_id_93" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span></span><br><span
class="text_12xnp">PICKERINGTON</span>, <img id="PERSGTY_FORM:j_id_98" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_12xnp">OH</span><img
id="PERSGTY_FORM:j_id_9a" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_12xnp">43147</span>
<br><br>
</td>
</tr>
</tbody>
</table>
<table>
<tbody>
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<td>
<br>
<span class="text_12x"><label>The following company has listed you as a reference on our Credit Application form in consideration for credit. Please find below a signed authorization from the company authorizing you to provide
electronic credit reference.</label>
</span>
</td>
</tr>
</tbody>
</table>
<table style="width: 100%;">
<tbody>
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<td colspan="2"><span class="text_12x"><label>Please provide us the following information using the electronic credit reference input form on the next page (by clicking on - </label>
<i><label>Provide credit reference</label></i><label>):</label></span></td>
</tr>
<tr>
<td width="50%">
<li style="margin-left: 50px;">Years in business with customer </li>
<li style="margin-left: 50px;">Average checking/savings balance (last 12 months)</li>
<li style="margin-left: 50px;">Current checking and savings account balance </li>
<li style="margin-left: 50px;">Returned / Dishonored checks - NSF?</li>
<li style="margin-left: 50px;">Line of credit amount(if any) </li>
<li style="margin-left: 50px;">Balance on line of credit (if any) </li>
<li style="margin-left: 50px;">Highest credit given (if any) </li>
<li style="margin-left: 50px;">Credit re-payment experience (if any) </li>
<li style="margin-left: 50px;">Overall rating</li>
</td>
<td><button id="PERSGTY_FORM:j_id_b6" name="PERSGTY_FORM:j_id_b6" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-icon-left backButtonTop" aria-label="" onclick="" style="background-color: #FFFFAC"
type="submit"><span class="ui-button-icon-left ui-icon ui-c ui-icon-circle-triangle-e"></span><span class="ui-button-text ui-c">Click here to provide credit reference</span></button>
</td>
</tr>
</tbody>
</table>
<div id="PERSGTY_FORM:j_id_b9" class="ui-panel ui-widget ui-widget-content ui-corner-all noborder" style="background-color: #f5f5f5;" data-widget="widget_PERSGTY_FORM_j_id_b9">
<div id="PERSGTY_FORM:j_id_b9_content" class="ui-panel-content ui-widget-content">
<table>
<tbody>
<tr>
<td><span class="label_13x">Credit Applicant/Your customer:</span>
<br>
<span class="text_12xnp">826 W MAIN SPRINGFIELD INC <br>826 W Main St<img id="PERSGTY_FORM:j_id_bv" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw==">
<br>Springfield, <img id="PERSGTY_FORM:j_id_c0" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw==">OH<img id="PERSGTY_FORM:j_id_c2" width="5" height="1" alt=""
src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw==">45504 <br><span class="label_11">Phone: </span>(380) 203-4216<img id="PERSGTY_FORM:j_id_c7" width="5" height="1" alt=""
src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw==">
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<br><br>
</span><span style="color: #ce0000; font-family: Tahoma; font-weight: bold; font-size: 9pt">NOTE: Internal records with your company:</span>
<br><span class="label_12x">Account/ID number: </span>
<br><span class="label_12x">Account type: </span>Checking
</td>
</tr>
</tbody>
</table>
<br>
<div class="card-header">
<h5 class="card-title"><span class="label_13x">Authorization For Electronic Credit Reference</span>
</h5>
</div>
<div id="PERSGTY_FORM:j_id_f4" class="ui-panel ui-widget ui-widget-content ui-corner-all noborder" style="margin-top: 0px;" data-widget="widget_PERSGTY_FORM_j_id_f4">
<div id="PERSGTY_FORM:j_id_f4_content" class="ui-panel-content ui-widget-content"><span class="text_12x">
<style>
.authorization_css_01_a {
font-family: Tahoma;
font-size: 9.0pt;
}
</style>
<table cellpadding="0" cellspacing="0" class="noBorder">
<tbody>
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<td class="authorization_css_01_a">The undersigned agrees and authorizes <b>Core-Mark US, LLC.</b> or any other reporting service employed by <b>Core-Mark US, LLC.</b> to obtain credit reference information from
<b>HEARTLAND BANK</b>. </td>
</tr>
</tbody>
</table>
</span>
<table class="signTable" style="width:99%; text-align: left; ">
<tbody>
<tr>
<td><label class="textLabel">Application Completed By</label>
</td>
<td><label class="text_12x">LAITH BANEKHALID</label>
</td>
<td><label class="textLabel">Title</label>
</td>
<td><label class="text_12x">Owner/Proprietor</label>
</td>
</tr>
<tr>
<td><label class="textLabel">Authorized Signatory</label>
</td>
<td colspan="3"><label class="text_12x">LAITH BANEKHALID</label>
</td>
</tr>
<tr>
<td><span class="textLabel">Signature</span>
</td>
<td><img id="PERSGTY_FORM:j_id_g5"
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alt="" class="img-fluid">
</td>
<td><label class="textLabel">Date</label>
</td>
<td><span class="text_12x">Jun 07, 2024</span><br><span class="text_12x">09:55 AM CDT</span>
</td>
</tr>
<tr>
<td align="right" colspan="4"><small class="font-italic"><label>Public IP:</label><span class="textLabel">155.190.19.5</span></small></td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
</div>
<br>
<table>
<tbody>
<tr>
<td>
<span class="text_12x"><label>We will appreciate your quick response.</label>
<br><br><label>Sincerely,</label>
<br><br><span class="text_12xnp">Becky Dishon</span>
<br><span class="text_12xnp">Accounts Receivable Coordinator</span>
<br><span class="label_13x">Core-Mark US, LLC.</span><br><span class="text_11x">1500 Solana Blvd.</span><img id="PERSGTY_FORM:j_id_n6" width="5" height="1" alt=""
src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">Suite 3400</span>
<br><span class="text_11x">Westlake</span> ,<img id="PERSGTY_FORM:j_id_nb" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">TX</span><img
id="PERSGTY_FORM:j_id_nd" width="5" height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">76262</span> ,<img id="PERSGTY_FORM:j_id_ng" width="5"
height="1" alt="" src="data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACH5BAEAAAAALAAAAAABAAEAAAICRAEAOw=="><span class="text_11x">US</span>
<br><span class="text_12xnp">(937) 525-1841</span>
<br><span class="text_12xnp">becky.dishon@pfgc.com</span>
</span>
</td>
</tr>
</tbody>
</table>
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<b><span style="font-size:10.5pt;font-family:"Arial",sans-serif;mso-fareast-font-family: "Times New Roman";color:#362B36;mso-font-kerning:18.0pt">AGREEMENT
AND AUTHORIZATION-To be completed by Applicant, and a Joint Applicant/User of Account if any.<o:p>
</o:p></span></b>
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<span style="font-size:10.0pt;font-family: "Arial",sans-serif;mso-fareast-font-family:"Times New Roman";color:#362B36">The Applicant, and the Joint Applicant/User of Account, if any (together, the "Applicant"),
submit the information contained in this credit application ("Application") for the purpose of persuading and inducing Core-Mark US, LLC., its direct and indirect subsidiaries and its successors and assigns ("Core-Mark") to make
periodic sales of goods to Applicant on credit, and upon specific terms set forth in Core-Mark's invoices. Applicant's signature below and/or Applicant's acceptance of invoiced merchandise, individually or through its agents or
employees, constitute an agreement by Applicant to pay all amounts owed promptly and within the terms of Core-Mark's invoices. Applicant agrees with Core-Mark that Applicant will pay a service charge of 1 1/2% per month on all past
due amounts, plus all collection costs (including collection agency fees in the event that the past due amounts are placed with a collection agency), expenses and attorney fees, if Applicant fails to pay or otherwise perform its
obligations to Core-Mark. A lawsuit need not be filed to allow an award of such attorney fees, expenses and costs and collection agency fees, and those attorney fees, expenses and costs shall include, by way of example, those incurred
in making demand, preparing for, or at trial, appeal and for collection of any judgment obtained. Any dispute, claim, or controversy between Applicant and CoreMark arising from this account (if the account is eventually authorized by
Core-Mark) shall be governed in all respects by the laws of the State from which the goods arc shipped. Applicant and Core-Mark agree that as to any dispute, claim or controversy, the parties agree that the jurisdiction and venue
shall be in the State and County from which the goods are shipped.<o:p></o:p>
</span>
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<p class="MsoNormal" style="margin-top:7.5pt;mso-margin-bottom-alt:auto; line-height:normal;background:white">
<span style="font-size:10.0pt;font-family: "Arial",sans-serif;mso-fareast-font-family:"Times New Roman";color:#362B36">Applicant and Core-Mark further agree that at the option of Core-Mark, any dispute, claim or
controversy between Applicant and Core-Mark shall be determined by arbitration in accordance with the Commercial Arbitration Rules of the American Arbitration Association. Upon issuance of an Arbitration Award, judgment maybe entered
in any court having jurisdiction thereof. Arbitration shall be held in the City and State from which the goods are shipped and shall be governed on all questions of law, according to the laws of the State from which the goods are
shipped. The Arbitrator shall award reasonable attorney fees and costs to the prevailing party, as well as reasonable arbitration, administrative, and arbitrator fees and costs. Any award of attorney fees shall include those fees
necessary to establish the award as judgment, as well as any reasonable attorney fees and costs prior to arbitration or other legal action arising from a breach of this Agreement. If any provision of this Agreement is found to be
unenforceable or invalid, it shall not affect the remaining provisions, and this Agreement shall be construed as if any such unenforceable or invalid provision were omitted.<o:p></o:p></span>
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<span style="font-size:10.0pt;font-family: "Arial",sans-serif;mso-fareast-font-family:"Times New Roman";color:#362B36">The information in this Application is submitted for the purpose of verifying and answering
questions as they relate to the credit experience of Applicant. Core-Mark is relying on the accuracy of all information provided, and in the event of any inaccuracy, the credit made available by Core-Mark shall be deemed to have been
procured by fraud. Applicant also specifically authorizes Core-Mark to answer questions about its credit experience with Applicant. Applicant certifies that the information provided in this Application is true and correct. Core-Mark
is hereby authorized to contact any credit bureau, credit or consumer reporting agency and also any credit reference and/or other reference listed on this Application to obtain one or more credit or consumer reports bearing on
characteristics of the Applicant including, but not limited to, Applicant's credit worthiness, credit standing, credit capacity, character or general reputation, at such times and in such manner as Core-Mark deems reasonable or
necessary. Applicant understands that Core-Mark will retain this Application <span class="GramE">whether or not</span> it is approved.<o:p></o:p></span>
</p>
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<span style="font-size:10.0pt;font-family: "Arial",sans-serif;mso-fareast-font-family:"Times New Roman";color:#362B36">Applicant may not assign, delegate or otherwise transfer the account established pursuant to this
Application, nor shall the relationship between Core-Mark and Applicant be assignable or <span class="SpellE">delegatable</span> by Applicant without the written consent of Core-Mark.<o:p></o:p>
</span>
</p>
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<span style="font-size:10.0pt;font-family: "Arial",sans-serif;mso-fareast-font-family:"Times New Roman";color:#362B36">Any cash discount is forfeited if invoices are not paid by due date. A continuing service charge
of 1 1/2% will be assessed monthly on all balances past due. Applicant agrees to pay reasonable attorney and collection agency fees, expenses and costs incurred by Core-Mark in enforcing its rights of collection, before the beginning
of court action or arbitration, at trial or arbitration, at any appeals therefrom, and for any collection efforts thereafter.<o:p></o:p></span>
</p>
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<span style="font-size:10.0pt;font-family: "Arial",sans-serif;mso-fareast-font-family:"Times New Roman";color:#362B36">All amounts owed to Core-Mark by Applicant pursuant to this Application shall become immediately
due and payable to Core-Mark upon the sale of Applicant (whether by sale of stock, merger, sale of all or substantially <span class="GramE">all of</span> the Applicant's assets or a similar transaction).<o:p>
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*
* Core-Mark US, LLC.
1500 Solana Blvd.Suite 3400
Westlake,TX76262,US
ELECTRONIC CREDIT REFERENCE REQUEST
Click here to provide credit reference
Electronic Credit Reference Request
Core-Mark US, LLC.
1500 Solana Blvd.Suite 3400
Westlake,TX76262,US
Date of Request :Jun 7, 2024- Re: Credit Application - REQ02487084
HEARTLAND BANK
421 HILL RD
PICKERINGTON, OH43147
The following company has listed you as a reference on our Credit Application
form in consideration for credit. Please find below a signed authorization from
the company authorizing you to provide electronic credit reference.
Please provide us the following information using the electronic credit
reference input form on the next page (by clicking on - Provide credit
reference): Years in business with customer Average checking/savings balance
(last 12 months) Current checking and savings account balance Returned /
Dishonored checks - NSF? Line of credit amount(if any) Balance on line of credit
(if any) Highest credit given (if any) Credit re-payment experience (if any)
Overall rating Click here to provide credit reference
Credit Applicant/Your customer:
826 W MAIN SPRINGFIELD INC
826 W Main St
Springfield, OH45504
Phone: (380) 203-4216
NOTE: Internal records with your company:
Account/ID number:
Account type: Checking
AUTHORIZATION FOR ELECTRONIC CREDIT REFERENCE
The undersigned agrees and authorizes Core-Mark US, LLC. or any other reporting
service employed by Core-Mark US, LLC. to obtain credit reference information
from HEARTLAND BANK.
Application Completed By LAITH BANEKHALID Title Owner/Proprietor Authorized
Signatory LAITH BANEKHALID Signature Date Jun 07, 2024
09:55 AM CDT Public IP:155.190.19.5
We will appreciate your quick response.
Sincerely,
Becky Dishon
Accounts Receivable Coordinator
Core-Mark US, LLC.
1500 Solana Blvd.Suite 3400
Westlake ,TX76262 ,US
(937) 525-1841
becky.dishon@pfgc.com
Click here to provide credit reference
Privacy Policy | Terms Of Use
© Copyright 2010 - 2024 Bectran, Inc. All rights reserved
Electronic Credit Reference Request
Document: Date Created:
Terms & Conditions
AGREEMENT AND AUTHORIZATION-To be completed by Applicant, and a Joint
Applicant/User of Account if any.
The Applicant, and the Joint Applicant/User of Account, if any (together, the
"Applicant"), submit the information contained in this credit application
("Application") for the purpose of persuading and inducing Core-Mark US, LLC.,
its direct and indirect subsidiaries and its successors and assigns
("Core-Mark") to make periodic sales of goods to Applicant on credit, and upon
specific terms set forth in Core-Mark's invoices. Applicant's signature below
and/or Applicant's acceptance of invoiced merchandise, individually or through
its agents or employees, constitute an agreement by Applicant to pay all amounts
owed promptly and within the terms of Core-Mark's invoices. Applicant agrees
with Core-Mark that Applicant will pay a service charge of 1 1/2% per month on
all past due amounts, plus all collection costs (including collection agency
fees in the event that the past due amounts are placed with a collection
agency), expenses and attorney fees, if Applicant fails to pay or otherwise
perform its obligations to Core-Mark. A lawsuit need not be filed to allow an
award of such attorney fees, expenses and costs and collection agency fees, and
those attorney fees, expenses and costs shall include, by way of example, those
incurred in making demand, preparing for, or at trial, appeal and for collection
of any judgment obtained. Any dispute, claim, or controversy between Applicant
and CoreMark arising from this account (if the account is eventually authorized
by Core-Mark) shall be governed in all respects by the laws of the State from
which the goods arc shipped. Applicant and Core-Mark agree that as to any
dispute, claim or controversy, the parties agree that the jurisdiction and venue
shall be in the State and County from which the goods are shipped.
Applicant and Core-Mark further agree that at the option of Core-Mark, any
dispute, claim or controversy between Applicant and Core-Mark shall be
determined by arbitration in accordance with the Commercial Arbitration Rules of
the American Arbitration Association. Upon issuance of an Arbitration Award,
judgment maybe entered in any court having jurisdiction thereof. Arbitration
shall be held in the City and State from which the goods are shipped and shall
be governed on all questions of law, according to the laws of the State from
which the goods are shipped. The Arbitrator shall award reasonable attorney fees
and costs to the prevailing party, as well as reasonable arbitration,
administrative, and arbitrator fees and costs. Any award of attorney fees shall
include those fees necessary to establish the award as judgment, as well as any
reasonable attorney fees and costs prior to arbitration or other legal action
arising from a breach of this Agreement. If any provision of this Agreement is
found to be unenforceable or invalid, it shall not affect the remaining
provisions, and this Agreement shall be construed as if any such unenforceable
or invalid provision were omitted.
The information in this Application is submitted for the purpose of verifying
and answering questions as they relate to the credit experience of Applicant.
Core-Mark is relying on the accuracy of all information provided, and in the
event of any inaccuracy, the credit made available by Core-Mark shall be deemed
to have been procured by fraud. Applicant also specifically authorizes Core-Mark
to answer questions about its credit experience with Applicant. Applicant
certifies that the information provided in this Application is true and correct.
Core-Mark is hereby authorized to contact any credit bureau, credit or consumer
reporting agency and also any credit reference and/or other reference listed on
this Application to obtain one or more credit or consumer reports bearing on
characteristics of the Applicant including, but not limited to, Applicant's
credit worthiness, credit standing, credit capacity, character or general
reputation, at such times and in such manner as Core-Mark deems reasonable or
necessary. Applicant understands that Core-Mark will retain this Application
whether or not it is approved.
Applicant may not assign, delegate or otherwise transfer the account established
pursuant to this Application, nor shall the relationship between Core-Mark and
Applicant be assignable or delegatable by Applicant without the written consent
of Core-Mark.
Any cash discount is forfeited if invoices are not paid by due date. A
continuing service charge of 1 1/2% will be assessed monthly on all balances
past due. Applicant agrees to pay reasonable attorney and collection agency
fees, expenses and costs incurred by Core-Mark in enforcing its rights of
collection, before the beginning of court action or arbitration, at trial or
arbitration, at any appeals therefrom, and for any collection efforts
thereafter.
All amounts owed to Core-Mark by Applicant pursuant to this Application shall
become immediately due and payable to Core-Mark upon the sale of Applicant
(whether by sale of stock, merger, sale of all or substantially all of the
Applicant's assets or a similar transaction).