Kor-Lok USA, LLC.
Credit Application

Remit To Address:  P.O. Box 451076 Houston, TX  77245-1076

Physical Address:  15060 West Dr., Suite 100 Houston, TX  77053

Tel: 281.437.8400    Toll: (US) 877.456.7565      Fax: 281.437.8437

 

Company Information:                                                 Date of Application:

Name of Business:_____________________________         Legal (If Different)_________________________

PH# ________________________              Fax:____________________ E-Mail_____________________________

Address:___________________________ City:__________________ State:_________ Zip:_______________

If Division / Subsidiary, Name of Parent Company:_____________________ Years in Business:________

 

 

Years in Business:            

Check One:          Corporation______            Partnership_______          Proprietorship_____

 

Officer or Owner:                                                                                                 Title:

 

Officer:                                                                                                                 Title:

 

Billing Address: (If Different from Above)

 

                                       R                             Institution Name :_________________________________

                                       E

B             F                             Checking Account:________________________________

                        A             E

                        N             R                             Address:_________________________________________

                        K             E             

                                       N                             Name of Officer / Contact:__________________________

                                       C

                                       E                             Phone:___________________________________________

 

Trade Reference:

 

Company Name:________________________________ Address:__________________________ Phone:____________________

 

Company Name:________________________________ Address:__________________________ Phone:____________________

 

Company Name:________________________________ Address:__________________________ Phone:____________________

 

I hereby certify that the information contained herein is complete and accurate.  The information included in this credit application is for use by Kor-Lok USA, LLC. For determining the conditions of credit to be extended.  I understand that Kor-Lok USA, LLC. May also utilize other sources than that of this application and give release necessary to make this determination.  Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to Kor-Lok USA, LLC. For which it is being applied for in order to verify the information contained herein.

 

Signature:____________________________________ Title__________________________ Date:_________________