Credit Application

Credit Application

Date:
Company Name:

Billing Address:
City:			State: Zip:
Shipping Address:
City:			State: Zip:

Phone Number:			Fax Number:
Type Of Business:
Kind Of Business:

Owners Or Partners Name and Address

Name:
Address:
City:			State: Zip:

Name:
Address:
City:			State: Zip:

Vendor (trade) References (include phone and fax numbers)

1.)

2.)

3.)

Anticipated Annual Purchases

*Please Send Copy Of Tax Exempt Form If Applicable*

Terms and Conditions

Terms: 2% 10th prox net 30 days. Accounts over 30 days accrue a service charge of 1.5% per month on the unpaid balance. All returned material subject to 20% handling charge. $5.00 delivery charge applies to all deliveries.

I, we agree that all purchases made on this account, individually, by an employee, or any other agent with actual or apparent authority to make a purchase o this account shall be governed by the above stated terms. In conjunction with this application, the Lakeside Supply Company is authorized to verify the information supplied herein and to receive and exchange credit information about the named company or individual, now and in the future. In the event this account is referred to an attorney for collection, all cost of collection including but not limited to, court cost and reasonable attorney fees, shall be an additional charge on this account.

I accept			I decline

The above needs to be signed verifying your agreement to all of the above terms and conditions of Lakeside Supply Company.

I,, personally guarantee payment to the Lakeside Supply Company for all purchases and fees chargeable to the above stated account. This guarantee shall be enforceable at any time portion of the account past due.

I accept			I decline

All Charges Are Subject To Approval Of This Application