Comments

This field is for validation purposes and should be left unchanged.

Applicant Name*

Date*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Shipping Address*

Street Address Address Line 2 City State ZIP Code

Person to Contact (for billing)*

Person to Contact (for shipping)*

Phone (for billing)*

Phone (for shipping)*

Preferred method of invoice receipt*

USPS
Email

Invoice Email*

Expected Monthly Purchases*

See #3 under the Terms below.

Corporation?*

Yes
No

Partnership?*

Yes
No

How long have you been in business?*

Vendor or Federal ID No.*

Customs Broker:*

Canada RM#*

Will purchase be tax exempt?*

(If yes, return with tax exemption certificate.)

Yes
No

Upload tax exemption certificate*

Max. file size: 50 MB.

Are purchase orders required?*

Yes
No

Trade References: Three required (other than bank or credit cards).

Reference #1

Name*

First Last

Company*

Account Number*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Reference #2

Name*

First Last

Company*

Account Number*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Reference #3

Name*

First Last

Company*

Account Number*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Reference #4

Name

First Last

Company

Account Number

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email*

Terms

1) Interest will be charged on all invoices not paid within 30 days of the invoice date (2% per month or 24% annual rate)
2) All PAST DUE accounts are subject to Cash or Delivery (C.O.D.)
3) $400,00 yearly average is normally required for open account status.

In any event, if any charges(s) ever occurring on this account, are placed for collection or suit, I agree to pay all collection charges, costs, attorney fees, and legal interest on all charges not paid. In consideration of extending credit to the proceeding named, I do hereby guarantee the payment of such sum or sums of money as may be due to any work, service or goods purchased through Lefeld Welding & Steel Supplies, Inc.

I understand and agree to meet Lefeld Welding & Steel Supplies, Inc. terms of Net 30 days if an account is established. I also certify that all information given herein is true and correct, and authorize any credit inquiries necessary to establish this account.

Date*

Company Name*

Signed By*

Title*

This form must have signature of applicant, or authorized representative of applicant, before credit approval information can be obtained and charge account established. Thank You!

Untitled

Charge Account Application

Terms