Full Company Name ___________________________________________________ Years in Business _____________ Ship to Address __________________________________ City_______________________ State _____ ZIP__________ Bill to Address ___________________________________ City_______________________ State _____ ZIP __________ Telephone No. __________________________ A/P Contact Person _________________________ Title _____________ BUSINESS STRUCTURE Type of Structure ____________________________________________________________________________________ President ________________________________ SSN _____________________________ Phone __________________ Address _________________________________________ City _______________________State_____ ZIP__________ Vice President_____________________________SSN______________________________ Phone __________________ Address _________________________________________City_________________________State_____ZIP__________ TRADE REFERENCE Name _________________________________________________________ Phone ______________________________ Address _________________________________________ City ________________________State _____ZIP_________ Contact Name _________________________________________________Fax # ________________________________ Name__________________________________________________________ Phone _____________________________ Address _________________________________________ City ________________________ State _____ZIP_________ Contact Name __________________________________________________ Fax # ______________________________ Name ________________________________________________________ Phone _______________________________ Address _________________________________________ City ________________________ State _____ ZIP________ Contact Name: ___________________________________________________ Fax _______________________________ BANK REFERENCES Name ______________________________________Account___________________________Phone_________________ Address__________________________________________ City________________________State_____ ZIP__________ Contact Name _______________________________________________ Fax # __________________________________ I/We agree to make all payments within our 30-day terms with Lin Mfg. & Design. In the event it becomes necessary to file a lien, suit, or engage a collection agency or attorney, I/We agree to bear all expenses incurred, including but not limited to attorney fees, court cost, and interest. I/We agree and acknowledge that in the Superior Court of Utah, in and for the County of Cache, is the proper venue and jurisdiction for the litigation of, or performance of any matters relating to this credit application, or the account. I hereby release any credit or financial information to Lin Mfg. & Design or its assignees: By signing I am accepting your conditions of sales. Authorized Signer and Title: Signature ___________________________________________ Date ___________________ |
Please print, complete, and fax to 775-665-4184 for approval |
