Landmark Credit Application

CREDIT APPLICATION

Today’s Date:

Date Business Began:

Company Name:

Billing Address:

Street Address City State / Province / Region ZIP / Postal Code

Shipping Address:

Street Address City State / Province / Region ZIP / Postal Code

Telephone #:

Email Address:

FIN or S.S. #:

Type:

Corp

Individual

Partnership

Tax Exempt # (certificate required):

P.O. Required?

Yes

OFFICERS AND CONTACT PERSONS

Officer:

Title:

Address

Street Address City State / Province / Region ZIP / Postal Code

Telephone #:

Social Security #:

A/P Contact:

Officer:

Title:

Address

Street Address City State / Province / Region ZIP / Postal Code

Telephone #:

Social Security #:

A/P Telephone #:

TRADE REFERENCES

Please complete all six references. For faster service, please provide an email address.

Company name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Company name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Company name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Company name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Company name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

Company name:

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone

I agree to payment terms of Net 30 Days from the invoice date. I understand that my account is subject to a # - #.# % monthly (##% annum) service fee for all invoices over 30 days. Accounts that reach 60 days will automatically by placed on C.O.D. status.

Submitted by:

Title:

Signature

Telephone #:

Date:

CREDIT APPLICATION

OFFICERS AND CONTACT PERSONS

TRADE REFERENCES

CALL US

QUICK LINKS

LOCATION

HOURS OF OPERATION

FORKLIFT RENTALS

CONNECT TO US