K&S Industrial Credit Application
Please fill out the below information
Legal Company Name
*
Trade Name - DBA (if applicable)
Company Contact Name
*
First Name
Last Name
Company Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Contact Email Address
*
example@example.com
Company Website
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Accounts Payable Contact
*
First Name
Last Name
Accounts Payable Email Adress
*
example@example.com
Accounts Payable Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How would you like monthly statements to be delivered?
*
Emailed
Mailed
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Purchasing Information
Do you require a PO# on invoices
*
Yes
No
If yes, who do we contact for a purchase order?
First Name
Last Name
Purchase Order Contact Email
example@example.com
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Company Information
Type of Business
*
Please Select
Sole Proprietor
LLC
C-Corp
S-Corp
Government Agency
Other
State of Registration
*
Federal ID#
*
Upload a current W9
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
What is your Sales Tax rate?
*
7% MS Sales Tax
1.5% Sales Tax
Direct Pay
Tax Emempt
Upload a copy of your Sales Tax ID #
*
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Drag and drop files here
Choose a file
Cancel
of
Number of Employees
Nature of Business
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Owner/Officer Information
Owner /Officer #1
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Owner / Officer #2
First Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Trade References 1
Business Name
*
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Trade Reference #2
Business Name
*
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Trade Reference #3
Business Name
*
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Date of Application
-
Month
-
Day
Year
Date
Signature of person completing this form:
Thank you for your interest in a Term 30-Day account!
Please submit this document and someone from our office will be in contact with you about your term account decision.
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