Credit Application

Company Name(Required)

DBA

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Phone #(Required)

Email(Required)

Enter Email Confirm Email

Purchasing Contact

Finance (Accounts Payable) Contact

Name(Required)

Office #(Required)

Phone #(Required)

Email(Required)

Transmit invoices(Required)

Digital Email

USPS Mail

Federal identification number(Required)

D-U-N-S number

Legal name if different than account name

Is applicant doing business under any other names?(Required)

Yes

If yes, give name(s) and location(s)

Describe nature of business(Required)

Has the company ever filed for bankruptcy?(Required)

Yes

If yes, give date

Year business started(Required)

Number of years under present owner(Required)

Terms and Conditions of All Sales

I, the authorized representative of the Buyer, understand and agree that any contract that is formed between the Buyer and S A S of Luxemburg, LLC and/or Builtrite/Lemco., the Seller, (hereinafter “Seller”), is expressly conditioned on the following terms and conditions which shall apply to all invoices submitted by Seller to Buyer. Seller Terms are available online at www.sasforks.com.

I also understand and agree that it is a condition of any contract formed between Buyer and Seller that any terms or conditions that are contained in any acknowledgement, including without limitation any purchase order issued by Buyer, which contains any terms or conditions that are inconsistent with or in addition to the terms and conditions of Seller, shall have no force and effect, and that expressly rejects such inconsistent terms and/or conditions.

I also understand and agree that the Seller terms shall automatically become a part of all invoice contracts unless Seller and Buyer expressly agree otherwise in writing. This contract contains the entire agreement between parties, and the failure of either party to enforce any of its rights hereunder shall not constitute a waiver of any rights hereunder.

Customer/Credit Information: Buyer represents and warrants that the information provided in this application for account and acceptance form for terms and conditions of all sales is warranted to be true.
Credit: SAS reserves the right at any time to suspend or change credit terms provided herein or to require full or partial payment in advance if, in SAS’s sole opinion, the financial condition of the Buyer warrants.

Company (Buyer)(Required)

Buyer signature(Required)

Date of (Buyer) customer acceptance(Required)

Name & title(Required)

Credit References

Feel free to attach/submit information on your company letter head.

Please give one bank and three commercial credit references

How would you like to provide credit references?(Required)

Upload Attachments

Manual Entry

Attachments

Drop files here or

Max. file size: 2 GB, Max. files: 5.

Bank

Credit Reference 1

Bank name

Company name

Contact name

Address

Street Address Address Line 2 City State ZIP / Postal Code

Address

Street Address Address Line 2 City State ZIP / Postal Code

Phone #

Account #

Credit Reference 2

Credit Reference 3

Company name

Contact name

Address

Street Address Address Line 2 City State ZIP / Postal Code

Address

Street Address Address Line 2 City State ZIP / Postal Code

Phone #

Tax Exempt Status - ** If you claim tax exempt, please attach tax exempt form from all states with this status.

Credit line requested

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