Credit Application

Your Contact Information

Company *

First Name *

Last Name *

Telephone *

Extension *

Title *

Email *

Web Address *

Billing Address

Address 1 *

Address 2 *

City *

State *

Zip *

Country *

Telephone *

Shipping Address

Address 1 *

Address 2 *

City *

State *

Zip *

Country *

Purchasing Manager

First Name *

Last Name *

Email *

Telephone *

Extension *

Accounts Payable Manager

First Name *

Last Name *

Email *

Telephone *

Extension *

Requested Terms

Terms *

Comments *

I agree that our company will submit payment via ACH / Wire.

I hereby have the authority and agree to submit payment within the terms agreed by the Seller and Buyer. In the event the sales invoice shall be placed by KulKote, LLC in the hands of an attorney for the purpose of collection, with or without litigation the Buyer agrees to pay any and all cost associated with such placement, including, without limitation, attorney's fees and costs incurred prior to, during, or subsequent to trial, and including, without limitation collection, bankruptcy, or creditor's rights proceedings. Invoice aging is calculated from invoice date.