Application for credit /
Thank you for your interest in establishing an account with LeJeune Bolt Company. In order to establish credit, this form must be completed in its entirety and returned to:
LeJeune Bolt Company
Attn: Karla Berg, Controller
Direct Phone: 952.843.5439
Fax: 952.890.3544
email:
Your corporate security is important to us. Information provided in this application will only be used to establish credit with LeJeune Bolt Company and will not be shared with any company, group, or individual.
COMPANY INFORMATION
NAME: Click here to enter text.
MAILING ADDRESS: Click here to enter text.
CITY: Click here to enter text.STATE: Click here to enter text.Zip: Click here to enter text.
SHIPPING ADDRESS: Click here to enter text.
CITY: Click here to enter text.STATE:Click here to enter text. Zip: Click here to enter text.
PHONE: Click here to enter text.FAX: Click here to enter text.
BUSINESS CLASSIFICATION:☐CONTRACTOR ☐DISTIRBUTOR ☐ERECTOR
☐FABRICATOR ☐MAINTENANCE & REPAIR ☐OEM ☐MISCELLANEOUS
OWNERSHIP INFORMATION
TYPE:☐CORPORATION ☐PARTNERSHIP ☐INDIVIDUAL
DATE ESTABLISHED: Click here to enter text.
FEDERAL TAX I.D. NO: Click here to enter text.
PRINCIPALS 1) Click here to enter text. 2) Click here to enter text. 3) Click here to enter text.
BANK INFORMATION
NAME: Click here to enter text.
ADDRESS: Click here to enter text.
ACCOUNT NO: Click here to enter text.
PHONE NO: Click here to enter text.
BANK OFFICER: Click here to enter text.
TRADE REFERENCES
BUSINESS NAME: Click here to enter text.
CITY: Click here to enter text. STATE: Click here to enter text. CONTACT: Click here to enter text.
PHONE: Click here to enter text. FAX: Click here to enter text. EMAIL: Click here to enter text.
BUSINESS NAME: Click here to enter text.
CITY: Click here to enter text. STATE: Click here to enter text. CONTACT: Click here to enter text.
PHONE: Click here to enter text. FAX: Click here to enter text. EMAIL: Click here to enter text.
BUSINESS NAME: Click here to enter text.
CITY: Click here to enter text. STATE: Click here to enter text. CONTACT: Click here to enter text.
PHONE: Click here to enter text. FAX: Click here to enter text. EMAIL: Click here to enter text.
I attest that the above information is true and accurate to the best of my knowledge. By authorizing and returning this form, I agree to LeJeune Bolt Company’s Terms and Conditions of Sale.
AUTHORIZED BY: Click here to enter text.
TITLE: Click here to enter text.
PHONE NO: Click here to enter text.
EMAIL: Click here to enter text.
Date: Click here to enter a date.
For more information contact us at
I 3500 West Highway 13, Burnsville, MN 55337 I 800.872.2658
02-008-01