APPLICATION FOR CREDIT PLEASE TYPE OR PRINT

Tool Dudes LLC P.O. Box 240497 Milwaukee, WI 53224 (877) XXX-XXXX ph (877) XXX-XXXX fax Contact Us

We do not accept NET-30 accounts for opening orders under $500. For smaller orders please use major credit card, mail-in a check, money order, or cashier's check. Allow up to 10 business days for check to be processed.

NAME OF COMPANY _________________________________________ PHONE # _______________

NAME OF PARENT COMPANY _________________________________ FAX # __________________

Street Address__________________________________________________________________________

City, State Zip _______________________________________ Email Address _____________________

KIND OF BUSINESS____________________________________________________________________

DUN & BRADSTREET # ____________________________ EIN _______________________________

Year Established _____________ Year Incorporated ___________ Present Location Since ____________

TYPE OF OWNERSHIP: Corporation _______ Partnership _________ Sole Proprietorship _________

Owner’s Name(s) ________________________________________ SS # __________________________

President ___________________________ SS # ________________ Vise Pres _____________________

Purchasing Agent ___________________________ Accounts Payable ____________________________

HOW DID YOU HEAR OF US? ___________________________________________________

PO # REQUIRED? YES ____ NO ____ WRITTEN PO REQUIRED? YES ____ NO ____

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REFERENCES: (OPEN ACCOUNTS WITH FAX NUMBERS ONLY)

NAME __________________________________ NAME _______________________________________

ADDRESS _______________________________ADDRESS ____________________________________

CITY _________________ ST ___ ZIP ________ CITY _________________ ST ___ ZIP _________

PHONE _________________ FAX ______________ PHONE _______________ FAX _______________

NAME __________________________________ NAME _______________________________________

ADDRESS _______________________________ADDRESS ____________________________________

CITY _________________ ST ___ ZIP _______ CITY _________________ ST ___ ZIP _________

PHONE ________________ FAX _____________ PHONE _________________ FAX _______________

NAME __________________________________ NAME _______________________________________

ADDRESS _______________________________ADDRESS ____________________________________

CITY _________________ ST ___ ZIP ________ CITY _________________ ST ___ ZIP _________

PHONE _________________ FAX ______________ PHONE _______________ FAX _______________

NAME __________________________________ NAME _______________________________________

ADDRESS _______________________________ADDRESS ____________________________________

CITY _________________ ST ___ ZIP _______ CITY _________________ ST ___ ZIP _________

PHONE ________________ FAX _____________ PHONE _________________ FAX _______________

BANK(S) ____________________________________ ACCOUNT # ____________________________

______________________________________ ACCOUNT # ____________________________

The above information is for purposes of obtaining credit is warranted to be true and accurate. You have my authority to contact any of the above persons or companies to verify my credit experience. I understand that the terms are NET 30 DAYS and I agree to pay a 1-1/2% (APR 18%) Service Charge on all invoices past due. The undersigned also agrees to pay ALL costs of collecting delinquent payments including attorney’s fees.

Signature ___________________________________________ Title _______________ Date _________

Print Name _________________________________________