Headquarters | 500 N. Westshore Blvd, Suite 435, Tampa FL 33609

Customer Onboarding & Credit Application

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Welcome to the Quala Family, we’re glad you’ve decided to partner with us as a customer!

Please fill out the secure webform below to complete a credit application to be reviewed by our financial team. You can also download a print copy of the form below and return the completed form to QHL-CreditAppRequest@quala.us.com

Any payments made with a credit card are subject to a 2% processing fee. If credit is granted, terms are net 30 unless otherwise documented.

Company Information

Company Director/Officer/Principal Information

Financial Contact Information

Trade References

Special Billing Instructions

i.e. Driver, BOL, etc.

Bill to Location

Method of Payment

Signature Section

Click or drag files to this area to upload. You can upload up to 5 files.

Payment and Invoicing

Payment for all services rendered, are due as stated on the invoice. Any item disputed, must be done so in writing within 30 days from the invoice date. Failure to initiate a dispute within this timeframe will waive your right to dispute that invoice. A dispute on a particular invoice does not waive your right to withhold payment on non-disputed invoices. The customer agrees to pay all costs of collection or legal fees should such action be necessary due to non-payment.

Failure to pay invoices in a timely manner may result in your account being placed on Credit Hold. Credit Hold may happen as early as 15 days from the due date stated on the invoice date. If your account is placed on Credit Hold, all services will be suspended until your account is brought in good standing.

Should your account continue to remain past due, the account may be placed in default and be turned over to legal counsel for further actions. Default status may happen as early as 60 days from the invoice due date.

Tax Exemption Status

If your Company is exempt from state Sales Tax, it is your responsibility to provide a valid exemption certificate at the time of this application or at such time when you become eligible for exemption. Upon receipt of a valid certificate, we will perform the necessary tasks to establish tax exemption to the account. All taxes invoiced prior to receipt of a valid exemption certificate must be paid in full.

Finance Charges and Non-Sufficient Funds (NSF)

We reserve the right to assess finance charges of 1% per month (12% per annum) on all invoices that are past due. Customers with past due amounts will receive a finance charge invoice each month. Finance charges will be assessed as of the end of the month and reduced by any amounts in dispute and any payments received by month-end but not posted. Customer agrees to pay $50 for each check issued, which is returned unpaid or marked NSF.

In signing this Application, customer agrees to all of the above and hereby grants permission for credit information to be verified by company(s) and financial institution(s) that the Customer has specified on this document and others that become evident during the credit review process. If the applicant is not a corporation, we are authorized to obtain credit reports on the proprietors, partners, or principals. The undersigned also understands that we will retain this application, whether it is approved or not, and that we will consider this application as a continuing statement of the undersigned’s financial position and situation until notified otherwise.

Faxed documents will be deemed as original. No oral agreements will be accepted. The terms on this credit application/agreement overrides all others.

By signing this credit application/agreement, the individual executing this application below on behalf of the customer, individually and personally, represents and warrants to us that:
(1) He/She is authorized to execute this application on behalf of the customer.
(2) The information set forth in this application is accurate and complete.
(3) All transactions are subject to the Terms and Conditions found on the Quala website