Today's Date    SETS Contact Person             John A. Michele John R. Matt Jonathan Nathan

Your Company Information:

Name   

Address

Phone                         Fax                       E-mail 

Account Payable Contact Name

Phone                         Fax                       E-mail 

Billing Address

Type of Ownership:                     Sole Proprietor Partnership Corporation

Type of Business:                          Apartment Complex Assisted Living Facility Commercial Contractor Government Agency Hotel/Motel Industrial Facility Landlord Medical Facility Property Management Religious Facility Restaurant

Credit References:

1. Name   

    Address

    Phone       Fax                       E-mail 

2.  Name   

    Address

    Phone       Fax                       E-mail 

3.  Name   

    Address

    Phone       Fax                       E-mail 

Are there any judgments or legal proceedings pending or threatened?

                Please Explain

Service Site Information:

Name   

Address

Phone               Fax                       

On-Site Contact Name 

Are there any special procedures that need to be followed for billing purposes?

ie. purchase order number

            Please Explain

Names of persons permitted to authorize work by South East Total Service, LLC. 

         1.        

         2.

         3.

Credit Application to South East Total Service, LLC, its subsidiaries or affiliates from  , my/our firm:

1. I/We authorize you to contact consumer credit reporting agencies, all bank, credit and trade references herein to verify our credit standing with them and authorize them to release said information to you.
2. Invoices past due thirty days are subject to an interest rate of 2% per month (24% per year) on any balance not paid in full upon completion of work.
3. The customer agrees to pay a service charge of $35.00 for any check not honored by the drawee for any reason.
4. If South East Total Service, LLC refers your account to an attorney or collection agency, customer agrees to pay South East Total Service, LLC the sum of $150.00 in addition to any other sum owed under the terms of the agreement.
5. If South East Total Service, LLC brings any type of legal action against the customer to enforce any of its rights under this agreement or to collect any amount showing under this agreement the customer agrees to pay South East Total Service, LLC's attorney's fees, which in any event, the parties agree shall be no less than $300.00.  In addition, the customer agrees to pay any court costs incurred by South East Total Service, LLC with regard to said legal action.
6. The customer acknowledges that the price quoted is only an estimate and that unforeseen problems may be discovered once work is commenced.  Should South East Total Service, LLC encounter, during the process of the work, subsurface or latent physical conditions at the site of an unusual nature, differing materially from those ordinarily encountered and generally recognized inherent in work of the character provided for in this agreement, customer agrees to pay for any additional work not herein contemplated that may be necessary to complete the work provided for in this agreement.  If the customer advises South East Total Service, LLC not to perform such additional work, the customer agrees to pay the original estimate price in full and South East Total Service, LLC shall have no further obligations under this agreement.
7. No assignment of this agreement or of any duty or obligation shall be made in whole or in part by the customer without written consent of South East Total Service, LLC.
8. This agreement shall be governed and construed in accordance with the laws of the State of Tennessee.

Name of person filling out this form       (required)

Title                                  

Telephone Number        (required)

Date                                   (required)

This form will be reviewed and a completed copy will be faxed to the Accounts Payable contact person listed above for original signature.  Upon receipt of signed credit application by return fax, payment terms will be set.

By pressing the submit button, I attest that all information contained in this form is true and accurate.