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CREDIT / BILLING AGREEMENT
   
Location:
Staffing Consultant Number:
CLIENT ADDRESS
Name:    
Contact:  
Address: 
City:         State:       Zip:
BILLING ADDRESS
Name:    
A/C payable
Address: 
City:         State:       Zip:
Phone   -     Ext.
Fax   -  
E-mail *(Required)
SITE INSPECTION
Complete Job Description:
Type/s of safety equipment required
# of workers per day:

BILL RATES AND WORKERS COMP CODES
Description: W/C Code: Bill Rate:
Description: W/C Code: Bill Rate:

TRADE REFERENCE

Should be an existing, active vendor with significant volume and a trade relationship for at least one year!

Company Contact    Phone   -  
Address:
City:         State:       Zip:
   
Company Contact    Phone   -  
Address:
City:         State:       Zip:
   
Company Contact    Phone   -  
Address:
City:         State:       Zip:
   
BANK REFERENCES
Deposit Bank
Branch Acc#
Contact
Phone -   Date Opened / /
Loan Bank
Branch Acc#
Contact
Phone -   Date Opened / /
Terms:Total amount due upon receipt.  Accounts 30 days past due are subject to interest at 1 ½% per month (18% annual rate.)  If an account is referred to an attorney for collections , customer shall pay the reasonable attorney’s fees and court costs incurred by Surestaff.
ACCEPTANCE

The undersigned hereby certifies that the information in this credit /billing Agreement is correct.  One Source Staffing and/or its agents are authorized to make investigations of our credit. The undersigned authorizes the bank and trade references listed above to release any information necessary to assist One Source Staffing in making its determination.  This agreement supersedes any agreement or understanding previously existing between One Source Staffing and customer relating though the subject matters contained herein.  This agreement, the Service Agreement including any guarantee set forth therein, or in a separate agreement shall be incorporated into this Agreement.  This agreement is reaffirmed as true and correct and the terms and conditions set forth herein are acceptable to customer.  This Agreement represents the whole arrangement of the parties and no modification or variation shall be deemed valid unless provided for and a subsequent agreement is signed by both parties hereto.
Client Authorized signature
Date
/ /

© 2009 One Source Staffing, Inc. All Rights Reserved

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