Business Credit Application - A & S Fabricating Co.

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Date

Business Information - Must Be Completed

Business Name*

DBA*

Street Address*

P.O. BOX*

City*

State*

Zip*

Phone*

Fax

Email*

Ship To

Company Name*

Street Address*

City*

State*

Zip*

Phone*

Fax

Email*

Type of Business*

Description Of Business:*

OEM Resale End User*

How Long in Business(years)*

Federal ID #*

Duns#(For this Bill To:)*

Do You Require Purchase Order Numbers?*

Amount Of Credit Needed?*

Are You Tax Exempt?*

(Kentucky Tax Will be Charged Unless We receive a copy of your resale or tax exemption certificate)

Bank Reference

Bank Name*

Bank Contact*

Phone #

Fax #

Email Address

3 Credit References Required

Company Name*

Address

Contact

Dept

Phone

Fax

Company Name*

Address

Contact

Dept

Phone

Fax

Company Name

Address

Contact

Dept

Phone

Fax

Terms And Conditions

Applicant's signature attests financial responsibility of applicants company's ability and willingness to pay for materials supplied according to our credit terms, which are NET 30 days. A & S Fabrication Co.(herein referred to as A & S) reserves the right to charge interest for invoices not paid according to these terms at the rate of 1 1/2% per month on the unpaid balance. A & S also reserves the right to limit or terminate credit if the account is not paid according to these terms and conditions.

General Provisions

This application and the information contained herein is a request for the extension of credit for commercial business use only. The applicant authorizes A & S to obtain a written or oral credit report from any credit reporting agency. Applicant further authorizes any bank or commercial business with whom the applicant is doing or has done any type of business to give any and all necessary information to A & S which will assist A & S in its credit investigation. The applicant further authorizes A & S to investigate the applicant's credit status from time to time as A & S deems necessary. Any changes in legal status must be communicated to A & S by certified mail. The original applicant will remain liable until such time as A & S has received notice of the change in legal status and been given a reasonable period of time to respond to such notice. Further, should this account be placed for collection the applicant agrees to pay all costs of collection including but not limited to attorney fees of 25%.

Title

Printed Name

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