|
We hereby make application to the Company for a Policy of Credit Insurance
in the amount of $. Said policy, if issued, to be on the form,
the terms and conditions whereof are agreed by us.
We herewith tender our application fee of $. Such fee is refundable if
no policy is issued.
- That the policy term shall be for the period of one year, beginning
, 20, and ending , 20.
- That the primary loss shall be calculated on sales made during said
year, but not less than $ at the rate of percent; the said
minimum primary loss to be not less than $.
- That no loss shall be covered by said policy that arises from any
account sold on terms longer than days, including dating.
Our answers to the following questions are true and pertain to sales to
companies located outside the United States, territories thereof and Canada.
- What is your line of business?
- How long at it?
- Have you kept books on account throughout that period?
Yes No
- Are you:
Wholesalers Manufacturers
- What line of merchandise constitutes the largest volume of business?
- To what line of trade is the greater part of your sales made?
- To what territory do you make your principal shipments?
- What are your terms of sale?
Open Account % Letter of Credit %
Other %
- For open account sales, what are your regular terms of sale?
Percent days, net days
- What are your longest terms of sale, including dating?
- About what percentage of sales to:
Manufacturers? % Wholesalers? %
Retailers? %
- Have you any information detrimental to the credit or responsibility
of any individual, firm, co-partnership or corporation to which you
have made or contemplate making any sale or shipment, to said policy,
if issued, will apply?
Yes No
If Yes, state particulars:
- Have you within the past year, or do you contemplate making any change
in your terms of sale, in the articles or commodities dealt in, in the
territory mentioned above, in the proportion of sales to manufacturers,
wholesalers or retailers, or in the manner of conducting your business?
Yes No
If Yes, state particulars:
- Have you any agreement to ship, or have you shipped, any merchandise
at a price higher than its current market price to which shipments
said policy, if issued, will apply?
Yes No
If Yes, state particulars:
- How many accounts did you place with attorneys or collection agencies
for collection during the past year?
- What was the average amount of such accounts?
$
- Have you ever carried credit insurance?
Yes No
If Yes, state with what company, and when the latest policy expired
or expires:
- How many active customer accounts are dealt with?
What is the amount of your present outstandings?
$
How much of the same now past-due under original terms of sale?
$
As a basis for the policy hereby applied for, and for any Policy of Credit
Insurance which may hereafter be issued to us, we warrant the following
statement of our sales, losses, and amounts owing by debtors under or
seeking general extension to be correct, and represent the combined experience
of our company and that of all entities to be insured under this Policy.
Maximum amount outstanding at any one time by buyer on export sales for the
last twelve months:
| Maximum Outstanding by Buyer |
Number of buyers in range |
| $0 - 25,000 |
|
| $25,001 - 50,000 |
|
| $50,001 - 75,000 |
|
| $75,001 - 100,000 |
|
| $100,001 - 300,000 |
|
| $300,001 - 500,000 |
|
| $500,001 - 1,000,000 |
|
| Over $1,000,000 |
|
This application and said policy, if issued, shall constitute the
entire agreement between the undersigned and the company; any verbal
or written statement, promise or agreement, by any agent of the said
Company, or notice to or knowledge of such agent or any other person,
to the contrary notwithstanding. It is also agreed that this application,
whether as respects anything contained therein or omitted therefrom has
been made, prepared, and written by the applicant or by his own proper
agent.
If corporation, so state; if firm or co-partnership, give the names of
the members; if "style name" used, so state.
Dated at: _____________________________________________________________________
this __________ day of ____________________________________________, 19___________
Signature of applicant ____________________________________________________________
PLEASE NOTE: We will FAX or MAIL you this
completed form for your signature. If you provide a FAX number above, the form
will be faxed; otherwise, we will mail you a copy.
|
|