A&K APPLICATION FOR CREDIT

APPLICATION FOR CREDIT
For established LA Grinding and AZ Grinding customers.

You can save your progress at any time by clicking "Save" at the foot of this page. Once saved, you can create a link which you use to share so multiple people can work on your application. All fields required unless otherwise stated.

Company / Entity Details
Company / Entity Name ("The Customer")*
e.g. COMPANY PTY LTD
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are Purchase Orders Required on all orders?*

YesNo
Billing Phone*
Billing Fax
Delivery Address (If different than Billing)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Delivery Phone
Delivery Fax

Ownership Information
Owner/Officer #1*

First NameLast Name
Owner/Officer #2

First NameLast Name
Company Structure*

CorporationPartnershipSole ProprietorLLCLLP
FED ID / SSN*
Year Company Established:*
Accounts Payable Contact*

First NameLast Name
Accounts Payable Email*
example@example.com

Bank Information
Bank Name*
Bank Contact Name*
Account Number*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Contact Phone Number*
Please enter a valid phone number.

Trade Reference #1
Trade Reference #1 Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Trade Reference #2
Trade Reference #2 Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Trade Reference #3
Trade Reference #3 Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Terms & Conditions
I hereby certify that all information on this application is correct and agree to abide by all the terms and conditions of L.A. Grinding Co. I further agree to abide by the payment terms of Net 30 days from the date of the invoice. Past due invoices are subject to a service charge of 18% per annum. Customer agrees to pay any and all collection costs, legal fees, or other expenses incurred to satisfy their debt. Customer grants permission to L.A. Grinding to contact applicant's bank and credit references. I certify I am authorized to sign this application on behalf of said company. Corporate accounts must be signed by an officer of the corporation.

A $30 service fee will be charged on all returned checks. I personally guarantee all amounts due L.A. Grinding incurred by above applicant.
Name of Signatory*

First NameLast Name
Title*
Signatory SSN
Signature*

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Date*

MonthDayYear
Date
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