Xpress Global Systems

Credit Application

Offline Submission

To download the Credit application form , Click here.

Please fax the completed form to XGS using the fax number (423) 510-6416

Credit Application For

Floor Covering Logistics
LTL Logistics
Installer's Choice

Company Requesting Credit
Date
Credit Line Requested
Company Name
DBA
Division / Subsidiary of
Company Address
City
State
Zip
Phone #
D&B Number
Type of Office
Type of Business
Date Business Started
Fed Tax#

Company Officers, Partners, or Proprietor 1
Name
Title
Soc Sec #
Home Address

Company Officers, Partners, or Proprietor 2
Name
Title
Soc Sec #
Home Address

Company Officers, Partners, or Proprietor 3
Name
Title
Soc Sec #
Home Address

Credit Reference 1
Name
Address
Phone
Date Opened
Current Bal
Terms

Credit Reference 2
Name
Address
Phone
Date Opened
Current Bal
Terms

Credit Reference 3
Name
Address
Phone
Date Opened
Current Bal
Terms

Accounts Payable
Contact
Phone
Fax
Email

Traffic Manager
Contact
Phone
Fax
Email

Primary Bank
Name
Account
Address
City
State
Zip
Phone

Application Agreement
* All Fields in Bold must be complete and the Application signed by a Principal. By execution of this application, You agree that the above information is true and accurate, and you agree to the Terms below and acknowledge the receipt of such terms. Permission is given to inquire as to applicants credit worthiness from any source. This information will be held in strict confidence and is strictly for credit purpose! I/we agree to pay all the debts incurred within the terms of sale. However, should the debt become past due, I/we expresly agree (subject to statutory regulation) to pay finance charges on the past due amounts at the rate of 1.5% per month (18% annual rate). I/we further expressly agree to pay reasonable collection cost and/or attorney's fees incurred in the connection with the collection of this account. Jurisdiction: The buyer hereby acknowledges doing business with Xpress Global Systems (hereafter referred to as "XGS") and hereby irrevocably consents and agrees that any legal action, suit or proceeding arising out of or in any way connected with buyer's transaction with XGS may be instituted by XGS in the State or Federal Courts having jurisdiction over Hamilton County, Tennessee as XGS, in its’ sole option, may elect. Buyer waives any objection to the forum selected by XGS and consents to the jurisdiction and venue thereof. The buyer further hereby acknowledges and agrees that any legal action, suit or other proceeding brought by buyer against XGS, in which buyer asserts any claim of any kind or nature may only be fulfilled in the courts of the State of Tennessee in the County of Hamilton, or the United States District Court of the Eastern District of Tennessee, unless XGS waives its right to object and consents in writing to another forum.
(Name)	(Date)

Individual, Personal Guaranty
I, , residing at and in consideration of your extending credit at my request to (Name of the Company) (herein after referred to as the "Company"), of which I am , hereby personally guarantee to you the payment at Xpress Global Systems in the State of Georgia any obligation of the Company, and I hereby agree to bind myself to pay you on demand any sum which may become due to you by the Company whenever Company shall fail to pay the same. It is understood that this guaranty shall be a continuing and irrevocable guaranty and indemnity of such indebtedness of the Company. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed.
(Name)	(Date)