Credit Application

Credit Application

Kathleen Mine LLC
Company Information
Company Name**
DBA
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country**
Phone
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Billing Country
Tax Identification #*
Type Of Business
# Of Years In Business
# Of Employees
Website
Legal Form (Corporation, Partnership, Or Proprietorship)
Contact Information
Name*

First NameLast Name
Title**
Email**
example@example.com
Phone**
Fax
Accounts Payable Contact Information
Name

First NameLast Name
Title
Email
example@example.com
Phone
Fax
Bank References
Bank
Account #
Phone
Contact
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Company Information
Company
Address
City
State
Zip
Country

Previous Company Information (Only Needed If In Business For Less Than A Year)
Previous Company
Address
City
State
Zip
Country
Credit Reference #1
Company
Contact
Email
example@example.com
Phone
Fax
Requested Credit
Requested Amount ($2,500 Minimum)**
Supporting Documentation
Please upload any additional documentation you may have, such as Tax Exemption Certificates.
File Upload

Cancelof
Terms
Our Terms of Sale are Net 30 and it is not contingent on when you receive payment. Invoices will be mailed to you promptly. To maintain a good credit history and to assure continued open account terms, it is important that all checks are mailed within 30 days from date of invoice. Invoices not paid in full within thirty (30) days of the date of invoice will accrue interest at the rate of 1 1/2% per month (18% per annum) on the unpaid balance. The failure to make timely payments may result in no further credit being granted. Payments on account will be applied first to any outstanding interest, then principle.
Applicant agrees to notify Kathleen Mine, LLC, INC. in writing when there are any material changes in the

information provided in this agreement. Upon request, Applicant agrees to supply Kathleen Mine, LLC, INC.with current financial statements.
Applicant agrees all payments will be remitted/made to the offices of Kathleen Mine, LLC, INC. at 5020 Old State Hwy 37, Mulberry, FL 33860 or other such addresses as Kathleen Mine, LLC, INC. may designate.
WORK/JOB TERMS
Applicant agrees upon acceptance of bid or quote, but in advance of work performed, to supply in writing to Kathleen Mine, LLC, INC. timely, proper, and accurate "Notice To Owner" information including copy of applicable "Notice Of Commencement" and name, address and phone number of the company/person for whom Applicant is working.
RECOVERY OF MONIES/FEES DUE
Applicant agrees: Should Kathleen Mine, LLC, INC. institute action to recover monies due on account, for credit extended, that Kathleen Mine, LLC, INC. will be entitled to recover from applicant all costs of collection, notice, filing, postage, express and attorney's fees.
RELEASE OF CREDIT INFORMATION
The undersigned hereby authorizes its bank, suppliers and other persons or entities with whom applicant is doing business, or who has knowledge of applicant's financial affairs, to release to Kathleen Mine, LLC, INC. information regarding applicant's credit history and other financial information regarding applicant.
AGREEMENT
The undersigned owner/officer/partner or member states that they are authorized to commit Applicant to all terms stated above
Check*

I acknowledge
Signature*

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I/We authorize Kathleen Mine, LLC, Inc or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.
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Credit Application

Company Information

Contact Information

Accounts Payable Contact Information

Bank References

Parent Company Information

Previous Company Information (Only Needed If In Business For Less Than A Year)

Credit Reference #1

Requested Credit

Supporting Documentation

Terms

WORK/JOB TERMS

RECOVERY OF MONIES/FEES DUE

RELEASE OF CREDIT INFORMATION

AGREEMENT