Credit Application

KMH Credit Application
Please use the form below in order for us to process your credit application. All fields are required.

1. Customer Information
Exact name of firm or corporation Phone Contact Name
Fax Physical Address Billing Address (leave blank if same)

2. Company Structure
Corporation Sate Partnership
General Limited Individual
Federal ID#    
   

3. Names of Principals

(required for all proprietors and partnerships and for corporations in business less than 2 years)
1 - Name Social Security Home Address
2 - Name Social Security Home Address
Type of Business Number of Years In Business  
 

4. Bank Secured References

(required for all proprietors and partnerships and for corporations in business less than 2 years)
1 - Name Social Security Home Address
2 - Name Social Security Home Address

5. Trade References
1 - Company Phone Contact Name
2 - Company Phone Contact Name
3 - Company Phone Contact Name
4 - Company Phone Contact Name
 
PARTIES HEREBY AGREE THAT ALL PURCHASES MADE ARE SUBJECT TO THE FOLLOWING TERMS AND CONCITIONS...
1. The undersigned purchase hereby agrees to pay service charges on accounts over 31 days old. These service charges will accrue at the rate of 1.5% per month (18% per annum or the maximum allowed by law).
2. The undersigned purchaser agrees to pay, in the event this account becomes delinquent and is turned over to any attorney for collection, reasonable attorneys fees plus all court and attendant collection costs.
3. The parties hereby acknowledge that the goods and/or services purchased are not payable in installments, but are payable in full as stated herein.