LOGIN OR REGISTER HERE Home About Our Products Application Contact H & H WHOLESALE – YOUR PRESCRIPTION FOR PROFITS Application for Credit Agreement Applicant (Company Or Trade Name) AP Email (For Invoices Only) Phone Billing Address Street Address City State ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Ship to Address Street Address City State ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Date Formed MM slash DD slash YYYY State of Incorporation Years In Business EIN Number Purchasing Agent First Last A/P Contact Phone Fax Credit Limit Requested $1000 $2000 $3000 $5000 $10,000 $15,000 $20,000 Credit limit Granted Payment By Credit Card or ACH desired: Yes No PRINCIPAL OFFICERS AND/OR PARTNERS 1. Name Dr. Miss Mr. Mrs. Ms. Prof. Rev. Title First Last Name Dr. Miss Mr. Mrs. Ms. Prof. Rev. Title First Last Email Email Phone Phone Address Street Address City State ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Address Street Address City State ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Credit References Bank - Name National Supplier - Name Regional Supplier Name Account # Account # Account # Address Street Address City State ZIP / Postal Code Address Street Address City State ZIP / Postal Code Address Street Address City State ZIP / Postal Code PLEASE ATTACH COPY FED TAX ID#, STATE RESALE CERTIFICATE & PHARMACY LICENSE Drop files here or Select files Max. file size: 2 GB. Authorization: By submitting this application to H&H Wholesale Services, Inc. ("H&H"), Applicant and Personal Guarantor(s) agree to the following: 1. Applicant and Personal Guarantor(s) authorize H&H to obtain credit bureau reports in connection with this request for a credit account. If a credit account is opened, H&H may obtain credit bureau reports for both the Applicant and the Personal Guarantor(s) in connection with extensions of credit, the review, or collection of Applicant's account. H&H will review Applicant's credit history and income to determine if Applicant qualifies for credit and, if so, Applicant's credit limit. H&H will also review Personal Guarantor's credit history and income to determine if the Personal Guarantor(s) qualifies as a guarantor of Applicant's account. 2. Upon approval of Applicant's credit line Applicant and Personal Guarantor(s) acknowledge and agree as follows: a. If a credit line is opened, Applicant agrees to pay the prices applicable at time of shipment. Unless otherwise agreed in writing, invoices are due 15 days following shipment regardless of date of invoice or date of receipt of invoice or product. Overdue accounts will bear a finance charge of 1-1/2% per month, or the maximum legally permissible charge, whichever is less. By using the credit line, or authorizing its use, Applicant agrees to additional Terms and Conditions of Sale as set forth on H&H invoices. b. By using the credit line, or authorizing its use, Applicant agrees to additional Terms and Conditions of Sale as set forth on H&H invoices. c. All persons signing this Application have authority to agree and expressly agree to receive faxes, email and telephone calls from H&H including, but not limited to, offers, advertisements and similar communications. d. On default or failure to pay as agreed, H&H may revoke Applicant's credit line, and Applicant and Personal Guarantor(s) will pay to H&H and/or its subsidiaries, affiliates, successors or assigns, all costs and expenses of collection including but not limited to attorneys fees, assessable costs, and litigation costs and expenses. e. Unless otherwise determined by H&H, all credits, bonuses and/or incentives offered or provided to Applicant and/or Personal Guarantor(s) must be taken or used within 12 months of the date granted, or such credits, bonuses or other incentives will expire. 3. Applicant and Personal Guarantor(s) consent to personal jurisdiction within Michigan and agree that Michigan is a convenient forum and hereby waive any objections to jurisdiction, venue and forum non conveniens. Applicant and Personal Guarantor(s) further agree that any any action will be governed by the laws of the State of Michigan, without regard to any conflict of law provisions. Any action or claim arising out of or relating to these Terms and Conditions of Sale, the sale of Product, or the relationship between the parties may be brought in the District or Circuit Courts of the State of Michigan, County of Oakland or, if it has or can acquire jurisdiction, in the United States District Court for the Eastern District of Michigan. 4. The Personal Guarantor(s) unconditionally, irrevocably and absolutely guarantees to and for H&H the Applicant's performance of the Terms and Conditions of Sale, including without limitation the prompt payment when due of any and all amounts owed by the Applicant to H&H under said terms (the "Obligations"). The Personal Guarantor(s) agrees that his/her obligations hereunder are irrevocable; that a separate action may be brought and prosecuted against the Personal Guarantor regardless of whether the Applicant is joined in any such action or whether H&H is seeking to enforce the Obligations against the Applicant. This is a continuing Personal Guaranty and shall remain in full force and effect and be binding upon the Personal Guarantor(s), its successors and assigns until satisfaction in full of all of the Obligations. The Personal Guarantor(s) acknowledges and agrees that the liabilities hereunder are direct and are not conditioned upon pursuit by H&H of any remedy H&H may have against the Applicant or any other person or any security. Personal Guarantor(s) acknowledges that a copy of this Application/Agreement has been or will be provided directly to the Applicant, and it shall be the responsibility of each Personal Guarantor(s) to obtain a copy of this Application/Agreement from the Applicant. 5. H&H warrants that products sold conform to specifications and disclaims all other representations and warranties, express, implied, statutory or otherwise including, without limitation, merchantability or fitness for a particular purpose, course of dealing, usage or trade practice, and noninfringement. H&H's sole liability shall be to refund or replace, at H&H's option, any product(s) covered by this Agreement which do not conform to specifications at the time of delivery. H&H is not responsible for normal variations in tolerance, dimensions, weights and quantity. All products sold by H&H are sold "as is". In no event shall H&H be liable for lost profits, loss of use, consequential damages, punitive damages or Applicant's use of the goods. If Applicant fails to notify H&H of any non-conforming product(s) in writing within five (5) business days of delivery, or within five (5) business days of discovery if reasonable inspection would not have disclosed non-conformance, Applicant shall be deemed to have waived its remedy. 6. In the event Applicant fails to pay any invoice(s) when due, within the stated allotment of time according to the terms of the credit agreement, H&H is authorized to initiate debit entries from DEPOSITORY, or charge CREDIT CARD, as indicated below for all amounts due in respect of those invoices and related collection costs and fees. 7. The terms and conditions set forth herein shall prevail over and supersede any terms and conditions contained in any of Applicant's purchase orders and/or releases. No change in this Agreement shall be binding upon H&H unless made in writing and signed by Applicant and H&H. The waiver by H&H of any breach of this Agreement shall not operate or be construed to be a waiver of any subsequent breach of this Agreement. 8. This application will not be processed unless the owner or principal of the Applicant signs this Agreement. I (we) hereby authorize H&H WHOLESALE SERVICES, INC. to initiate debit entries to my (our) Checking/Savings account (select one) with the depository named below, and to debit the same to such account. Depository Branch ROUTING/ASA NO ACCOUNT NO I (we) hereby authorize H&H WHOLESALE SERVICES, INC. to debit my (our) charge card indicated below. Credit Card Type Visa Mastercard American Express Name of Account Holder: Account Number: Expiration Date: Name of Account Holder: Security Code Billing Address Street Address City State / Province / Region ZIP / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini (Swaziland) Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Country Signature Date MM slash DD slash YYYY Applicant Personal Guarantor #1: Applicant Personal Guarantor #2: Applicant Personal Guarantor #3: Signature Signature Signature SS# (Required)* SS# (Required)* SS# (Required)* Date MM slash DD slash YYYY Date MM slash DD slash YYYY Date MM slash DD slash YYYY Phone 800.995.5750 248.616.3030 Fax: 248-616-3434 Email sales@hhwholesale.com Name First Last Company Name Email Message © 2021 H & H. ALL RIGHTS RESERVED.