Southern Welding Supply Credit Application

Name of Business:

Billing Address:

Type of Business:

Phone:

Fax:

Entity Type: Sole Proprietor C Corporation S Corporation Partnership Individual

Contact:

Accounts Payable Manager:

Years in Business:

Federal ID:

Do you collect sales tax?: Yes No

Purchase Order Required?: Yes No

Statement Requested?: Yes No

Email:

Job Number (if any):

Requested Credit Limit:

Section A - Complete Only if Corporation

Corporate or Home Address:
Principle Officer 1:	SSN #:
Principle Officer 2:	SSN #:
Principle Officer 3:	SSN #:

Section B - Complete Only if Partnership or Individual

Full Name of Partners or Individual:
Address:	SSN #:
Full Name of Partners of Individual:
Address:	SSN #:

Section C - Banking and Business References

Name of Bank:	Location:	Contact:	Account Number:
Business Reference 1:	Address:		Phone:
Business Reference 2:	Address:		Phone:
Business Reference 3:	Address:		Phone:

I hereby authorize Southern Welding Supply, Inc. to verify credit and check references. I state that the above is true to the best of my knowledge and belief. I have been advised of and understand the terms under which Southern Welding Supply, Inc. is extending me credit. I also understand that I personally guarantee all sums due to Southern Welding Supply, Inc., and that I will be held liable for Southern Welding Supply, Inc.'s costs to collect the sums due them in the event of default. Any account with a balance due past 60 days will be placed on credit hold. I further agree to pay service charges, collection costs, and reasonable attorney's fee in the event of default.

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