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General Company Information
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Company Legal Name*:
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Phone*:
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Billing Address*:
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City*:
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State/Province*:
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Country*:
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Zip/Postal Code*:
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Fax:
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Years Established*:
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E-invoicing*:
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Business Type*:
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Anticipated monthly purchases*: $
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Federal ID Number*:
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D&B Number:
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SIC Code:
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AP Contact
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First Name*:
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Phone*:
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Last Name*:
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Email*:
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Authorized Purchasing Agent
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First Name*:
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Phone*:
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Last Name*:
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Email*:
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Owners/Principals
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First Name*:
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Phone*:
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Last Name*:
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Title*:
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% of Ownership*:
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SSN*:
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Email*:
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First Name:
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Phone:
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Last Name:
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Title:
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% of Ownership:
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SSN:
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Email:
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Agreement
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This credit application is given to secure a credit line
with Kele, Inc. on Net 30 terms. Your application will be forwarded to our
Credit Department for further analysis in order to establish a permanent credit
line. I certify that the information contained herein is correct and true. The
undersigned officer hereby authorizes Kele, Inc. permission to obtain credit
information which will be kept strictly confidential.
Please forward an original signed application along with
your tax exempt certificate to dlcredit@kele.com or fax to 901-592-5756
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