NSW/Lynx Credit Application

NSW/Lynx Credit Application

& Customer Information Form
Date *

Month Day Year
Date
NAPOLEON/LYNX CONTACT

First Name Last Name
BUSINESS INFORMATION *
BILL TO ADDRESS *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
SHIP TO ADDRESS (If different from Bill To Address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
ACCOUNTS RECEIVABLE INFORMATION *
ACCOUNTS PAYABLE CONTACT INFORMATION *
PURCHASING CONTACT INFORMATION *
DATE BUSINESS WAS ESTABLISHED (OPENING DATE) *

Month Day Year
Date
FED ID# *
STATE ID# *
BUSINESS TYPE *
BUSINESS OWNER/PARENT COMPANY *

First Name Last Name
IS YOUR COMPANY SALES TAX EXEMPT? *

Yes No
IF YES, SALES TAX EXEMPTION #
ATTACH SALES TAX EXEMPTION CERTIFICATE FOR THE STATE MATERIALS BEING SHIPPED (IF NO CERTIFICATE IS PROVIDED, YOU WILL BE CHARGED SALES TAX).

Browse Files

Cancel of

TO BE CONSIDERED FOR OPEN ACCOUNT STATUS, PLEASE COMPLETE THE FOLLOWING

(A financial statement may be requested at a later date)
LINE OF CREDIT REQUESTED
BANK REFERENCE *
TRADE REFERENCE #1 *
TRADE REFERENCE #2 *
TRADE REFERENCE #3 *

CREDIT AGREEMENT

The following credit agreement must be signed for any business wanting to open an account with Napoleon/Lynx, regardless of credit terms status:
The information provided by the applicant and authorized by the undersigned has been provided for the purpose of obtaining or maintaining open account status with Napoleon/Lynx. The undersigned has also provided information that is true and correct and remain so until written notice of change is provided to Napoleon/Lynx. In addition, the undersigned authorizes Napoleon/Lynx to make any and all inquiries deemed necessary to verify the information provided including and not limited to pulling customer credit reports on any owners or principals of the company to verify the accuracy of the statements herein to determine my credit worthiness.

It is understood that by signing this application, I/We, the undersigned, acknowledges and accepts that a service charge may be added to past due invoices each month in the amount of 2.0% (Annual rate of 24%). In addition, I/We, the customer, agrees to pay all costs of collection, including reasonable attorney's fees. Each time a check is returned (bounced), a fee of $25.00 will be charged to the customer, regardless of the reason.
CREDIT AGREEMENT CONFIRMATION *
AUTHORIZED SIGNATURE *

Clear
PERSONAL GUARANTEE *
CREDIT AGREEMENT CONFIRMATION *
AUTHORIZED SIGNATURE *

Clear
EMAIL APPLICATION RECEIPT TO:
example@example.com
Should be Empty: