For Non-Taxable accounts, please include a properly completed sales tax exemption form.
Bill To Address:
Ship To Address (If Different Than Bill To):
The following authorization(s) apply to this application and apply subsequently for purposes of updating, renewing or extending credit and for reviewing or collecting any resulting credit extension. A photo-static or facsimile copy of this authorization will be valid as the original.
The federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington D.C. 20580. If this Application is denied, the undersigned have the right to a written statement of the specific reasons for the denial. Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
This is a business transaction, not a consumer transaction. By signing below, you hereby expressly affirm that, by completing this Application in any capacity, including, without limitation, as the principal of a formal business entity, a sole proprietor or a guarantor, even if your personal creditworthiness alone is the basis for establishing eligibility for services sought by this Application, you are seeking financing to purchase inventory, equipment, and/or goods for commercial and/or business purposes only, and not for personal, family or household use.
A) AUTHORIZATION TO CONTACT BY PHONE. BY SIGNING THIS APPLICATION, DSD EXPRESS, ITS AFFILIATES, AGENTS AND INDEPENDENT CONTRACTORS ARE AUTHORIZED TO CONTACT THE UNDERSIGNED USING ANY TELEPHONE NUMBER PROVIDED TO DSD EXPRESS OR FROM WHICH A CALL IS PLACED TO DSD EXPRESS, OR ANY TELEPHONE NUMBER WHERE DSD EXPRESS BELIEVES IT MAY REACH THE UNDERSIGNED, USING ANY MEANS OF COMMUNICATION, INCLUDING, BUT NOT LIMITED TO, CALLS OR TEXT MESSAGES TO MOBILE, CELLULAR, WIRELESS OR SIMILAR DEVICES AND CALLS OR TEXT MESSAGES USING AN AUTOMATED TELEPHONE DIALING SYSTEM AND/OR ARTIFICIAL VOICES OR PRERECORDED MESSAGES, EVEN IF CHARGES ARE INCURRED FOR RECEIVING SUCH COMMUNICATIONS. (B) AUTHORIZATION TO CONTACT BY OTHER MEANS. THE UNDERSIGNED ALSO AGREES THAT DSD EXPRESS, ITS AFFILIATES, AGENTS AND INDEPENDENT CONTRACTORS MAY USE ANY OTHER MEDIUM, AS PERMITTED BY LAW AND INCLUDING, BUT NOT LIMITED TO, MAIL, E-MAIL AND FACSIMILE, TO CONTACT THE UNDERSIGNED.(C) RIGHTS TO OPT-OUT OR MAKE CHANGES. IT IS UNDERSTOOD THAT AGREEMENT TO SECTIONS (A) OR (B) ABOVE IS NOT A CONDITION TO OBTAINING FINANCING FROM DSD EXPRESS. If opting out of section (A) and/or (B) is desired, or if the undersigned wants to change how DSD Express contacts the undersigned, including with respect to any telephone number that DSD Express might use, the undersigned may write to DSD Express at the address listed and identified below.
Signing below authorizes the release of credit information to DSD Express or its designee from any source including credit reporting agencies and the personal, bank, and credit references listed above: (i) to evaluate this Application; and (ii) if this Application is approved, for purposes of updating, renewing, extending, reviewing, servicing, and collecting on the account, as well as other legitimate purposes associated with the account. DSD Express will, upon request, advise whether a credit report was requested and, if it was, DSD Express will provide the name and address of the credit reporting agency that furnished the report.
It is understood that DSD Express may report information to credit reporting agencies about the undersigned. It also is understood that late payments, missed payments, or other defaults may be reflected in the undersigned’s credit report(s).
To dispute any information on a credit report that is reported by DSD Express, send a written notice of dispute to the DSD Express at the address listed and identified below. Disputes sent to any other address or that are not received from a credit reporting agency will not be investigated. A dispute must include the applicable account number, the specific information disputed, the basis for the dispute and all supporting documentation or other information to be considered.
Undersigned understand and agree that DSD Express may provide the information that the undersigned provide in this Application to its affiliates and its non-affiliated third-party business partners to use for the purpose of determining my eligibility for products or services requested by completing this Application and/or for their everyday business purposes in providing services that result from this Application. DSD Express’s affiliates may also use this information when they are considering whether to offer financial or other products or services to the undersigned. The undersigned agree that DSD Express may release any such information obtained as a result of this Application if it believes it is required to comply with any governmental or legal process, whether or not such release is actually required, or when it is necessary or desirable in connection with a transaction or investigating a potential loss.
Maine Residents: If this application is approved, I understand that: (i) I must maintain physical damage insurance on the collateral securing the debt; (ii) I have the right of free choice in the selection of the agent and insurer through which the insurance is placed (including the right to choose an agent or broker not affiliated with you); and (iii) obtaining insurance from a particular agent or broker will not affect DSD Express’s credit decision if DSD Express determines the selected insurance satisfies the terms of credit.
The undersigned agree that the place of making of this instrument is the State of Ohio and shall be construed and interpreted in accordance with the laws of the State of Ohio, without regard to its conflicts of laws principles, and shall be deemed to have been executed by undersigned within the geographic confines of the State of Ohio. Undersigned further agree that jurisdiction for the enforcement of any transaction made pursuant to, or arising out of and/or from this credit application shall be brought exclusively in the federal or state courts residing/situated in Henry County, Ohio. Any cause of action arising out of this Agreement shall be deemed to have arisen from a transaction of business in the State of Ohio, undersigned hereby irrevocably consents to the jurisdiction of such courts (and of the appropriate appellate courts therefrom) in any such suit, action or proceeding and irrevocably waives, to the fullest extent permitted by law, any objection that it may now or hereafter have to the laying of the venue of any such suit, action or proceeding in any such court or that any such suit, action or proceeding brought in any such court has been brought in an inconvenient forum. Process in any such suit, action or proceeding may be served on any party anywhere in the world, whether within or without the jurisdiction of any such court. Without limiting the foregoing, each party agrees that service of process on such party at the address identified by Applicant/undersigned, above, shall be deemed effective service of process on such party.
The undersigned hereto also hereby authorizes any attorney at law to appear in any court of record in the State of Ohio or any other state in the United States, at any time after accounts arising out of this application becomes due, whether by acceleration or otherwise, and to waive the issuing and service of process and confess a judgment in favor of DSD Express hereof, against the undersigned for the amount of principal, interest, and service fees then appearing due and owing, together with all costs of suit and DSD Express’ reasonable attorneys’ fees, and to release all errors and waive all rights of appeal. The undersigned further gives up all rights to a trial by jury.
WARNING - BY SIGNING THIS PAPER YOU GIVE UP YOUR RIGHT TO NOTICE AND COURT TRIAL. IF YOU DO NOT PAY ON TIME A COURT JUDGMENT MAY BE TAKEN AGAINST YOU WITHOUT YOUR PRIOR KNOWLEDGE AND THE POWERS OF A COURT CAN BE USED TO COLLECT FROM YOU REGARDLESS OF ANY CLAIMS YOU MAY HAVE AGAINST THE CREDITOR WHETHER FOR RETURNED GOODS, FAULTY GOODS, FAILURE ON HIS PART TO COMPLY WITH THE AGREEMENT OR ANY OTHER CAUSE.
It is agreed that this Application shall remain DSD Express’s property. The undersigned acknowledge receipt of a copy of this Application.
Undersigned agree if any term, provision, covenant or condition of this Application shall, to any extent, be declared to be invalid or unenforceable, the remainder of this instrument or the application of such provision, term, covenant or condition shall not be affected thereby, and each other term, provision, covenant or condition of this Application shall be valid and enforceable to the full extent permitted by law.
In consideration of credit being extended by DSD Express or its subsidiary to the above named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to pay DSD Express or its subsidiary the faithful payment, when due, of all accounts of said applicant for purchases made. The guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by DSD Express or its subsidiary, extension of time of payment to applicant, acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee.
It is further agreed that if payment is not received when due and if it is placed with an attorney, certified collection agency, or other avenue of collection, for collection that the undersigned guarantor(s) agrees to pay to all costs of collection, including a sum equivalent to one-third (1/3) of the amount referred to such collection agency or attorney, which the undersigned guarantor(s) agrees to be just and reasonable, or any court having jurisdiction shall determine to be just and reasonable, which shall immediately be added to the amount due.
This guarantee may not be waived orally and shall continue in full force and effect until such a time when DSD Express shall receive from the undersigned written revocation and such revocation shall not in any way relieve the undersigned from liability for indebtedness incurred prior to the actual receipt by DSD Express of such notice. All notices made by the undersigned pursuant to, or in any way arising from this instrument shall be sent certified mail with return receipt and the signed registry return receipt card shall be the best evidence thereof. Any revocation of this guarantee, and all other communications regarding any aspect of this instrument shall be in writing and delivered to DSD Express, Attention: Credit Department, T-480 County Rd 7, Liberty Center, OH 43532.
ALL ACCOUNTS WITH A BALANCE OVER THIRTY DAYS WILL BE ASSESSED A SERVICE CHARGE EQUAL TO 2.0% PER MONTH, AT AN ANNUAL RATE OF 24% A.P.R.
I (We) hereby certify that I (we) have read this document in it's entirety and accept its conditions, and further state all information supplied by the undersigned is true in fact and intent.
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Signed by Mike Filiatreau
Signed On: June 21, 2022
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Document Name: Credit Application
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