Credit Application Form

Company Identification
Company Information
Term & Conditions

By clicking submit below, I hereby represent that I am authorized to submit this application and bind the business identified in this application, and that the information provided is for the purpose of obtaining credit and is warranted to be true.

The business identified in this application acknowledges that this request is for the extension of credit for commercial purposes only and is not intended for the extension of credit for personal, family or household purposes. In order to protect individual identities, unless an individual is intending to act as a guarantor for purposes of securing credit and is required to provide guarantor information on this application, no personally identifying information (i.e. Social Security #, drivers license #, bank account information, etc.) should be provided.

The business identified in this application hereby authorized all banks, financial institutions, trade reference sources, credit reporting agencies and others to release credit information.

In the event of a conflict, the terms and conditions set forth above shall control over any terms and conditions set forth below.

Application Term & Conditions

Terms of sale on credit/credit agreement/personal guarantee
(please read carefully before signing)

  • The undersigned purchaser/guarantor agrees to the following terms of sale and conditions on all purchases made from CLEANLIFE® Energy.
  • Deliveries are cash on delivery until CLEANLIFE® Energy credit department has granted credit terms.
  • All amounts due for goods and services are payable in full.
  • All amounts due to CLEANLIFE® Energy are payable in accordance with payment terms granted by CLEANLIFE® Energy’s credit department.
  • Any and all amounts not paid in accordance with the credit terms as granted will be assessed a service/finance charge of 18% per year (1.5% per month).
  • Purchaser or guarantor shall pay 100.00 for any returned check or reversed electronic payment.
  • Purchaser or guarantor consents to the exclusive jurisdiction and venue of the Cuyahoga County Common Pleas Court, Ohio at the exclusive option of CLEANLIFE® Energy.
  • Purchaser or guarantor shall pay all court costs, attorney fees of (35%) of the balance due in the event that this account is turned over to an attorney or third party agent for collections of any and all amounts due.
  • Purchaser agrees to notify CLEANLIFE® Energy of any changes in ownership of the purchaser or guarantor by certified mail.
  • CLEANLIFE® Energy reserves the right to modify, discontinue or change any credit terms at any time.
  • CLEANLIFE® Energy reserves the right to close or suspend any credit account at any time without prior notice, regardless of the reason for the closure of the credit account with CLEANLIFE® Energy, and the purchaser or guarantor will remain responsible for the payment of the amount owed to CLEANLIFE® Energy and the terms and conditions of this agreement.
  • As a condition of CLEANLIFE® Energy extending credit to the purchaser/guarantor, the undersigned personally guarantees full performance and payment of the buyer for any and all products or services, plus service/finance charges, collection costs, attorney fees, returned payment items, and waives any protest, demand, and notice from CLEANLIFE® Energy, regarding this guarantee. It is further agreed that any use of titles with respect to individual signatures of the personal guarantor shall have no legal significance and shall in no way be construed to relieve the individual guarantors of the personal obligations under this paragraph and the terms and conditions stated herein.
  • By signing this agreement I accept and agree to be legally bound to the aforementioned terms and conditions. The party signing this agreement warrants that they are an officer, partner, or owner of the purchaser and or is authorized to bind the purchaser to the terms and conditions of this agreement.