Personal Application

To establish credit with our company it will be necessary for you, or your organization, fill out one of our credit applications below.

One may be obtained at any of our offices or plant locations, or by downloading the form. Credit applications must be submitted prior to establishing an open account with Manatt’s. Upon approval of the credit application, we will notify you by email or phone.

Personal Contact Information

First Name

Last Name

Driver's License #

City

State

Zip Code

Phone

Cell Phone

Fax

Receive Invoices by Email? YesNo

PO Required? YesNo

Bank Reference

Bank Name

Bank Address

City

State

Zip

Credit Reference 1

Credit Reference Company Name

Credit Reference Address

Credit Reference Phone

Credit Reference City

Credit Reference State

Credit Reference Zip

Credit Reference Fax

Credit Reference Email

Credit Reference 2

Credit Reference 2 Company Name

Credit Reference 2 Address

Credit Reference 2 Phone

Credit Reference 2 City

Credit Reference 2 State

Credit Reference 2 Zip

Credit Reference 2 Fax

Credit Reference 2 Email

Employment Information

Current Employer

How Long

Employer Address

Employer Phone

Employer City

Employer State

Employer Zip

Employer Fax

Employer Email

Hourly/Salary HourlySalary

Position

Annual Income

Applicant's signature authorized Manatt's, Inc., to contact your bank and credit references for the purpose of obtaining credit information. This release and agreement to terms of this application must me signed below before the application can be processed. Please mail application to: Manatt's, Inc., Attn: Credit Mgr, PO Box 535, Brooklyn, IA 52211-0535, fax to : (641) 522-9407, or email: suemcc@manatts.com. CreditSafe will be used for this application. As the applicant, I have listed information for the purpose of obtaining credit with Manatt's, Inc. The information supplied on this application is true and correct. Manatt's, Inc., is authorized to investigate the references listed and other sources to determine my credit standings and financial obligation. I do herby agree to pay any and all obligations to Manatt's, Inc, within 30 days of the date on the invoice. If, at any time, I fail to meet those terms, I agree to pay interest computed at the rate of 1 1/2% per month on the unpaid balance of the account, not to exceed 18% annually. In the event that Manatt's, Inc., should incur collection costs, charges and expenses, including but not limited to, reasonable attorney fees if the account is placed with an attorney for collection.

Personal Application Agreement

Personal Agreement Date