Lake Welding Supplies
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Contact
Menu
Home
Gases
About
Contact
Menu
Home
Gases
About
Contact
Account Application
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Business Name
*
Address
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City
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State
*
Zip Code
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Business Phone Number
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AP Contact
Current Conditions Principal
AP Phone Number
Year Established
Email
*
Principal Owner Name
*
Principal Owner Position
*
Principal Owner Phone
*
Trade Reference 1
*
First
Last
Trade Reference 1 Phone
*
Trade Reference 2
*
First
Last
Trade Reference 2 Phone
*
Current Welding Supplier
Supplies
Current Supplier Phone Number
Do you intend to rent cylinders from us, or will you be using your own cylinders for your welding needs?
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Rent cylinder for our needs.
No, we have own or intend to purchase our own.
Cylinders are not need at this time.
Current Bank Name
Current Bank Contact
Current Bank Phone Number
Is Purchase Order Required?
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Yes
No
Florida State Sales Tax
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Taxable
Exempt
Checkbox Items
*
Yes
We certify that the above information is true and correct and we agree to pay this account in accordance with your credit terms. We authorize you to verify this information and/or obtain additional information by securing data from a credit reporting agency. We understand that all past due balances will subject to 1½% per month service charge. We further agree to pay 25% collection charge, in the event of default, if the account is placed with an attorney or bonded collection agency. For good and valuable consideration, the undersigned (jointly & individually) agree to be personally liable for all indebtedness incurred by the above listed corporation or business entity. The undersigned (jointly & individually) further agree to be personally liable for all indebtedness based on the extension of credit to any other corporation or business entity with which the undersigned is or may be affiliated. If a default in the terms of payment occurs on any account on which the undersigned is or may be liable, and which is placed with an attorney or bonded collection agency, the undersigned (jointly & individually) agree to pay an additional 25% collection charge on the entire unpaid balance.
Terms & Conditions
*
I Accept the Terms and Conditions.
Submit Application