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1.800.275.6577 Outside USA 1.201.438.3515
Credit Application
All fields are required! accepted.
Corporation   Partnership   Sole Owner  
Individual or Company Name:  
Exact Legal Name:  
Address:  
City:     State:    Zip:  
Telephone:   Fax:  
Type of Business:   In Business Since  
Standard Industrial Code:   Credit Amount Requested:  
Tax Exempt Number:   D & B Rating:  
Application for credit is hereby made and the following references given. It is understood that this application will be held in strictest confidence.
Principals or Owners:  Bank Reference: 
Name:   Name:  
Address:   Address:  
City:    State:    Zip:   City:    State:    Zip:  
Home Phone:   Telephone:  
How Long in Business:   Account Number:  
Four Business References Where Credit is Now Extended:
Name:   Name:  
Address:   Address:  
City:    State:    Zip:   City:    State:    Zip:  
Telephone:   Telephone:  
Name:   Name:  
Address:   Address:  
City:    State:    Zip:   City:    State:    Zip:  
Telephone:   Telephone:  
Will payment be made from this location? Yes   No
If not, where:  
Your email address:  
I / We understand LPS' terms are net 30 days. If buyer fails to make payment as provided herein, a service charge of 2% per month shall be charged to all unpaid balances due, and buyer shall pay all costs and expenses, (including, but not limited to, counsel fees and expenses) incurred in connection with all efforts and attempts to collect payment and we agree to abide by them. Submission of this form authorizes LPS to check our credit references.