Credit Application

Applicant's Full Firm or Corporate Name *

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Address *

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Address Line 2

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State

Zip Code

Phone

Billing/AP Address

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Address Line 2

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Ship-to location(s) and phone number(s) where service is to be provided.

Ship-to location and phone number where service is to be provided. *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Ship-to location and phone number where service is to be provided.

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Address Line 2

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State

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Social Security Number *

Federal Tax ID Number *

List Names of Officers and Owners *

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How long have you been in business under this name? *

Previous company names of DBA's

Financial Institutions

Name and contact information of credit references.

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Bank Name *

Loan Officer *

First

Last

Account Number *

Bank Name

Loan Officer

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Last

Account Number

Bank Name

Loan Officer

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Last

Account Number

Bank Name

Loan Officer

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Account Number

Accounts Payable

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Name of the person(s) paying invoices. *

Accounts Payable *

First

Last

Phone Number *

Email *

Please read and complete.

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The undersigned hereby acknowledges that this application is submitted for the purpose of obtaining credit. The undersigned hereby represents that the foregoing statements are true, correct, and complete. I also represent that I am authorized to provide this information and enter into this credit agreement with Lift Truck Supply, Inc. The holder of this application is authorized to verify or authorize others to verify all information, and I agree to notify your company or its assigns of any material change of facts within 30 days of such change. This application/agreement shall remain the property of your company or its assigns.

Please check the box to authorize your credit check. *

I authorize Lift Truck Supply to verify financial and credit information.

Date *

Name *

First

Last

Title *

Please read and complete.

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CREDIT POLICY: I agree to pay all invoices on receipt or within 30 days, and that all invoices will be considered past due after the 30 days. All discrepancies must be brought to the attention of Lift Truck Supply within 30 days of the invoice date. If the invoice is not paid on demand, I agree to pay your reasonable attorney fees, court costs, and collection expenses, and agree that Texas law will govern any dispute. I also agree that any lawsuits regarding this debt will be filed in Smith County and I will accept service of any papers filed by you to collect this debt from me.

Date *

Name *

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Last

Title *

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C.O.D. ONLY ACCOUNTS

Companies or individuals that plan to buy often and want an account to keep track of previous orders and services can set up their account as COD.

C.O.D. ONLY ACCOUNT: Payment for COD accounts, Terms of payment are prior to or at time of delivery. Payment may be made by Check, Credit Card (Master Card, Visa, or Amex). Credit terms may be offered to an approved Customer. The customer is required to immediately pay all moneys owed to the Company Payment of accounts by credit card may attract a surcharge of 2% on all cards.

Date *

Name *

First

Last

Title *

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