NOTICE: Applicant and each other person signing below warrants that the information provided herein or in connection with this application is true and correct and authorizes the release of such information to any party who may provide credit to applicant, whether herein or pursuant to a subsequent application or request, to obtain from banks, credit bureaus and other creditors, all of which are hereby authorized to release any credit / financial information concerning applicant or such other person (including personal credit bureaus) as such party may deem appropriate, and to share all such information with the other.

By signing, customer has read and understands and agrees to all terms and conditions of credit from Puckett Rents. Do not sign this agreement until you have read it. You are entitled to a copy of the signed agreement. The applicant hereby authorizes any individual, firm or corporation given as a credit reference to disclose to Puckett Rents orally or in writing the information which is pertinent to this application.

By: Title: Date:
By: Title: Date:

NOTE: By typing your name above, you are authorizing your signature on this credit application.

FOR VALUE RECEIVED, the undersigned does guarantee payment of all amounts advanced by Puckett Rents to Applicant if Applicant defaults in its payment of any such indebtedness. The undersigned shall also pay to Puckett Rents all reasonable costs of collection, including a reasonable attorney's fee and court costs. This is a continuing guaranty and shall remain in full force until the undersigned delivers to Puckett Rents written notice revoking it as to indebtedness incurred subsequent to such delivery.

By: Title: Date:
By: Title: Date:

NOTE: By typing your name above, you are authorizing your signature on this credit application.
 

ADDITIONAL ACCOUNT INFORMATION:
Credit Limit Requested $    Purchase Orders Required: Yes No
Special Purchasing Requirements 
THIS APPLICATION IS FOR A RETAIL CHARGE ACCOUNT WITH Puckett Rents.
 

This is to certify that all purchases made by the undersigned from Puckett Rents are purchased for the following purposes. Please check one:
Non-taxable under Direct Pay Permit No.  
Non-taxable purchases are for resale. Resale Tax ID No.  
Purchases are to be used in the manufacturing process subject to 1 1/2 tax.
     Mfg. Tax Account No.
Other:
Regular MS State Sales Tax will be assessed to all purchases on accounts without documented proof of the claimed exemption.

In the event that Puckett Rents is compelled by the Mississippi State Tax Commission or any other taxing authority to pay any additional sales tax, interest and/or penalty in connection with any purchase or rental made by us, then I/we agree to pay Puckett Rents promptly the additional sales tax, interest and penalty.

TERMS AND CONDITIONS OF RETAIL CHARGE AGREEMENT
WITH PUCKETT RENTS

     1. This application is submitted by the undersigned (hereinafter referred to as "applicant") for the purpose of and in consideration of obtaining a credit account with Puckett Rents, a division of Puckett Machinery Company, collectively referred to hereinafter as "Puckett Rents". All representations are accurate, complete and truthful to the best of the Applicant's knowledge and belief.
     2. If the applicant is a corporation, partnership or limited liability company, the undersigned affirmatively states that he is authorized to make application on behalf of said organization and to obligate same for any credit extended thereto as a result of this application; and further that the corporation, partnership or limited liability company on whose behalf application is hereby made will continue to be bound and obligated for any credit advanced thereto until notice to the contrary is given in writing to Puckett Rents at 406 Hwy 49 South, Richland, Mississippi 39218.
     3. If Applicant presents a Financial Statement as part of this application, it will be attached hereto and made a part hereof. Applicant agrees to submit Financial Statements as requested by Puckett Rents. Any Financial Statements submitted in connection with this application or as requested by Puckett Rents will be accurate, complete and truthful.
     4. If credit is extended to Applicant by Puckett Rents, terms on parts and service invoices are net cash, 10th of the month following invoice date. Accounts which are not paid within one month's billing period after date of statement on which a charge first appears, will be assessed a delinquency charge at the maximum rate permitted by law. It is expressly understood that the existence of a delinquency charge does not affect Applicant's obligation to pay the account in full when due.
     5. If, after delinquency, Applicant's account is referred to an attorney for collection, Applicant agrees to pay reasonable charges incurred by Puckett Rents, including reasonable attorney's fee and court costs, whether or not a lawsuit is filed. Applicant agrees that this agreement is not effective until accepted at the home office of Puckett Rents in Richland, Mississippi. Applicant consents to jurisdiction and venue over any cause of action arising under this agreement in the County of circuit Court of Hinds County, Mississippi, or such other venue as Puckett may select, at its option.
     6. Waiver of right to trial by jury. Each party hereby irrevocably waives any and all right to trial by jury with respect to any legal proceeding arising out of or relating to this agreement or any transaction contemplated hereby.
     7. Puckett Rents liability for any damages claimed by applicant is limited to the purchase of the goods or services in question. Applicant agrees that Puckett Rents has a lien on any machine or engine until account is paid in full.

NOTICE: If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Credit Manager, c/o Puckett Rents, 406 Hwy 49 South, Richland, MS 39218, within 60 days from the date you are notified of our decision. We will send you a written statement of the reasons for the denial within 30 days from receiving your request. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit 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 Lender is the FTC Regional Office for the region in which the Lender operates or the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.