Personal Account Application – Lake Welding Supplies

Personal Accout Application

Email address you would like to use to receive invoices and statements? Invoices and statements are no longer being mailed.

Principle owners or stock holders are as follows:

Trade References:

Current Welding Supplier:

Banking Information:

Is Purchase Ordered Required?

Yes No

Florida State Sales Tax:

Taxable Exempt

If exempt, please attach certificate.

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.

I Accept the Terms and Conditions.

Credit Card Authorization Form.

Fill in the credit and attach it here