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Northern Factory Sales, Inc. 2701 4th Ave. SW • PO Box 660 • Willmar MN 56201
PH: 320-235-2288 • Fax: 320-235-5524
Application for Credit *** FILL OUT COMPLETELY TO BE CONSIDERED FOR CREDIT***
~~Preprinted credit information is acceptable – Please sign bottom of this application to authorize reference check~~ Company Name:__________________________________________________________________________________ Billing Address: _____________________________________ __________________ __________ _______________
Street & P.O. Number City State Zip Code
Shipping Address:________________________________ ______________ ___________ _______________ Street & P.O. Number City State Zip Code
Phone #:______________________ Fax #:_________________________ PO’S Required _____Yes ______No
Ownership: ______Corporation_____Partnership ______Proprietorship State Sales Tax #:_____________________
Type of Business: ______________________ Years in Business ______AuthorizedBuyer:_____________________
Federal Id#_______________________________ Web Address:___________________________________________
Receive invoices by: _____Email_____Fax _____Reg Mail / Email Address: ______________________________
OFFICER / OWNER INFORMATION:
________________________________________________ _____________________________________________________ Name Title Name Title
________________________________________________ _____________________________________________________ Address Address
TRADE REFERENCES: (Must be business trade references.) 1. _________________________________________________________________________________________________________ Name Address
____________________________________________________________________________________________________ Phone Fax
2. _________________________________________________________________________________________________________ Name Address
____________________________________________________________________________________________________ Phone Fax
3. _________________________________________________________________________________________________________ Name Address
____________________________________________________________________________________________________ Phone Fax
BANK INFORMATION:
Bank Name:___________________________________________________ Acct. No.____________________________ (Bank Required)
Address: ______________________________________________________Type of Acct:_____Checking______Savings Contact __________________________ Phone #________________________ FAX #___________________________ TERMS OF SALE: Net 10
th Prox – due and payable by the 10
th of the month following purchase. Any unpaid invoices by the 10
th will be considered past
due and interest will accrue at the end of the month at rate of 1 % (18% annually). By granting credit I/we agree that all incurred service charges,
collection costs and reasonable legal fees accrued by Northern in the event of a default can be added to the account balance. Your signature below indicates your full understanding and acceptance of these terms and authorizes the references given to release information to
Northern Factory Sales Inc.
_________________________________________ ________________________ _________________________ Authorized Signature Title Date
For Northern’s Use Only
Date Sent_____________ Approval____________ Date Approved____________ Customer #______________
Class________________ Whse______________ Credit Limit____________ Prospect #_______________
www.northernfactory.com
Email: [email protected]
