Application for Credit *** FILL OUT COMPLETELY
TO BE CONSIDERED
www.northernfactory.com FOR CREDIT***
Email: AR@lnfs.com
Northern Factory Sales, Inc. 2701 4th Ave. SW + PO Box 660 + Willmar MN 56201 PH: 320-235-2288 • Fax: 320-235-5524
--Preprinted credit information is acceptable - Please sign bottom of this application to authorize reference check...•...• Company Name:
_
Billing Address:
----_=__:__ __--
~~;:;-;::;-~:_;__:_-----~--~----____=_ Street & P.O. Number City
Shipping Address:
__
Zip Code
State
Zip Code
-;::-:-___:-:-::-::--:-:-__:_---------::-:----------::__---------Street & P.O. Number
Phone #:(
City
Fax #:(
Ownership:
State
Corporation __
County:
Partnership
Type of Business:
Proprietorship
Years in Business
Federalld#
_
State Sales Tax #:, AuthorizedBuyer:,
Web Address:
Receive invoices by: __
Email __
Fax __
_ _ PO's Req.:
YES I NO
Reg Mail / Email Address:
_
OFFICER { OWNER INFORMATION:
Title
Name
Name
Address
Address
TRADE REFERENCES:
1. __
(Must be business trade references.)
~------------------~~-----------------Name
Address
'Phone
2.
Fax
-------------------------
3. __
Title
--------------------------
Name
Address
Phone
Fax
~----------------------------------------Name
Address
Phone
Fax
BANK INFORMATION:
Bank Name:
Acct. No.,
---'-
_
(Bank Required)
Address:
Type of Acct __
Contact
'
- Phone #(
Checking
Savings
FAX.#(
TERMS OF SALE: Net io" Prox - due and payable by the io" of the month following purchase. Any unpaid invoices by the io" will be considered due and interest will accrue at the end of the month at rate of 1 Y2% (18% annually). By granting credit I{we agree that all incurred service charges, collection costs and reasonable legal fees accrued by Northern in the event of a default can be added to the account balance. Your signature below indicates your full understanding Northern Factory Sales Inc.
Date
Use Only
Date Sent, Class,
of these terms and authorizes the references given to release information to
Title
Authorized Signature For Northern's
and acceptance
-+-__ '--_
Approval, Whse
_ _
Date Approved Credit Limit,
_ _
Customer # Prospect #
_
past