New Customer - Credit Application Form

    Business Information

    Bank Information

    Credit References

    All information provided will be held in the strictest confidence

    Terms: Invoices are payable within 30 Days of invoice date. Proof of delivery must be requested within 21 days of invoice date on all normal delivery, express delivery must be requested within 10 days of invoice date. A finance charge of 1.5% per month will be assessed on all balances outstanding past terms. A 3% fee will be assessed for all credit card transactions. Returned merchandise will be refunded the full amount for unopened boxes within a period of 14 days. The undersigned assures that the information provided above is true and correct; and furthermore, herby authorizes the release of information form the listed credit references and banking institution to Smart Medical Solutions LLC.


    In Consideration of Smart Medical Solutions LLC extending credit to the above applicant, the undersigned personally guarantees the payment of all future obligations which may be owed to Smart Medical Solutions LLC as well as interest and reasonable attorney fees. Venue and jurisdiction for all actions necessary to enforce this agreement shall be held in Kings County, New York