image1.jpg
image1.gif
Your Order’s Will be Shipped C.O.D. By U.P.S. At No Charge
 To You Until Credit Application Is On File.
Ayers
Distributing
Corporate Offices
P.O. Box 1206
Kearney, NE 68847
800-325-4275
THE INFORMATION BELOW MUST BE RECEIVED BEFORE ANY EXTENSION OF CREDIT CAN BE GRANTED. IT IS IMPORTANT THAT THIS
APPLICATION BE FILLED OUT IN ITS ENTIRETY.
DATE
image2.gif
In consideration of the extension of credit to
Address                                                                                 City                             State               Zip
I (We) Personally guaranty payment of all indebtedness owed by
to Ayers Distributing. It is understood by and between Ayers Distributing and
that this guaranty shall remain in effect so long as there is any unpaid balance owing Ayers Distributing. It is further understood that this guaranty shall include any and all reasonable attorney or collection fees. The undersigned hereby authorizes the release of credit information by the above listed references for the purpose of establishing credit with Ayers Distributing.


WITNESS                                                                    GUARANTOR
image4.gif
image5.gif
image6.gif
image7.gif    
image8.gif
image9.gif
image10.gif
image11.gif
image12.gif

Please Fill out Completely and Fax to: 1-800-325-4275

NAME OF COMPANY______________________________ PHONE _________________
BUSINESS ADDRESS_____________________________CITY________ST___ZIP______
PERSON IN CHARGE OF ACCOUNT__________________PHONE_________________
HOME ADDRESS________________________________CITY________ST___ZIP_______
NAME OF BANK_________________________________BANK PHONE______________
BANK ADDRESS________________________________CITY________ST___ZIP_______
BANK CONTACT PERSON___________________________________________________
CREDIT REFERENCE_____________________________PHONE____________________
ADDRESS______________________________________CITY________ST___ZIP_______
CREDIT REFERENCE_____________________________PHONE____________________
ADDRESS______________________________________CITY________ST___ZIP_______