• Sales Representative________________________ Region____________ Customer Number____________________


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  • FileName: linc_credit_app.pdf [preview-online]
    • Abstract: Sales Representative________________________ Region____________ Customer Number____________________tax Code :____________ Frt Terms:________________________ Date:

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Sales Representative________________________ Region____________ Customer Number____________________
tax Code :____________ Frt Terms:________________________ Date:
Confidential Credit Application / Customer Set - Up
Linc Systems Inc.
16540 Southpark Dr. 800-513-9918 Payment Address:
Westfield, IN 46074 Fax 800-330-5481 PO BOX 1627
Indianapolis, IN
www.lincsystems.com 46206-1627
Credit Terms Requested: (Please Circle Terms & Credit Limit Requested)
C.O.D // Credit Card // 1%10-Net 30 Days // OTHER __________________
Credit Limit Requested (please Circle one or fill in dollar amount): ________________
$500 $1,000 $1,500 $3,000 $5,000 $7,000 $10,000 Greater
GENERAL INFORMATION A PO BOX address will require a secondary Physical street adress
Company Name (legal)___________________________________________________________
DBA:____________________________________________________________ Web Site
Business Mailing Address______________________________________________ Phone ( ) _______________
City, State Zip __________________________________________________ Fax ( ) ________________
Additional Shipping Address___________________________________________________________
City, State Zip __________________________________________________
Use additional sheets if more than 1 ship to location. A P.O. Box will require a secondary shipping address.
Authorized Contact or Purchasing Agent_____________________________ Phone ( ) _________________
Purchasing Email:_________________________________________________
Accounts Payable Contact______________________________________ Phone ( ) _________________
Payables Email:_________________________________________________ FAX ( ) ___________________
Federal ID_______________________ D L #_______________________State___________ Tax Exempt? YES // NO
Type of Business/Services/Products sold____________________________ How Long_____________ (Signed Tax Form must be attached)
(Check one) Sole Proprietor_________ LLC_________ Partnership_________ Corporation_________
Has you or your company ever filed Bankruptcy? __________ If so date filed___________ Registered Business?________
SSN or FED ID # required for NET Terms Greater than $1,000.00
Corporate Officers / Owners (Or FED ID #)
President / Owner________________________________ Social Security No.______________________
Vice President / Partner___________________________ Social Security No.______________________
Treasurer / Partner______________________________ Social Security No.______________________
15 = Construction 25 = Furniture/Cabinets/Casegoods 34 = Pallet Shops CLASS CODES for internal use
16 = Roofing/Insulation 26 = Allied 50 = Resale
17 = Commercial Construction 32 = Automotive
24 = Manufactured Housing 33 = Industrial fastening / Crating
I acknowledge that payment terms for an open account is 30 days & will pay all invoices within those terms.
**General information about your account..**
Any bounced check will have a $25 NSF Fee added into the balance. We do prosecute for uncollected NSF Balances.
WE reserve the right to charge any & all necessary fees involved involved in 3rd party collections or litigation on unpaid balances.
Accounts are periodicaly reviewed for payment patterns, as well as increases & decreases in credit terms & limits.
Applicant authorizes release of above information or attached reference list to Linc Systems Inc.
(Please sign below to authorize release & accept account terms & conditions as listed above)
**Signature __________________________________Printed Name_______________________DATE____________
rev 1.4 03-21-08 page 1 of 2
Linc Systems Inc.
16540 Southpark Dr.
Westfield, IN 46074
800-513-9918
www.lincsystems.com Fax 800-330-5481
ACCOUNT NAME____________________________ Linc Account Number____________________
BANK REFERENCES
Bank_______________________________________ Account No.__________________________ Type:______________
Address ____________________________________ Phone No.____________________________
City, State, Zip Code ___________________________ Fax No. ______________________________
___________________________ Contact ______________________________
Business or Personal Credit Line: $ ________________ Secured: yes_____ no______ Personal Guaranty: yes_____ no______
TRADE REFERENCES
Business Name ______________________________________Phone _____________________________
Address ____________________________________City, State Zip ________________________
Contact_____________________________________ Customer No. ________________________
Type of Business ________________________________________________________________
Business Name ______________________________________Phone _____________________________
Address ____________________________________City, State Zip ________________________
Contact_____________________________________ Customer No. ________________________
Type of Business ________________________________________________________________
For the purpose of obtaining products or services from Linc Systems Inc. the following statements are made by the Applicant and Linc Systems inc. should rely on
all such statements as correct. This agreement is between the applicant signed on this agreement and linc Systems Inc. Applicant authorizes Linc Systems to
contact any reference given and inquire about credit history. Applicant agrees to notify Linc Systems Inc. in writing within five days of any changes of ownership,
address, telephone, authorized purchasing agents, banks, transfer or listed assets, or other facts set forth. All Lines on page 1 need to be completed for acounts
that will present checks as payments.
Personal Guaranty
I _________________("Guarantor/Borrower") hereby guarantee to Lender ("Linc Systems Inc."), the prompt payment, when due, of each and every claim which
lender may have against borrower. This continuing guaranty shall remain in force until revoked by the undersigned by written notice to lender but any such
revocation shall be effective only as to any claims which may arise out of transactions entered into after certified receipt of revocation. This guaranty shall be
effective as to the renewal of any claims guaranteed hereby or extensions of time or payment, and shall not be effective as to the renewal of any claims
guaranteed hereby or extensions of time or payment, and shall not be hereby guaranteed. The Lender shall be under no obligation to give the undersigned notice
of renewals or renewls. In the event of default by Borrower in the making of any payments when due, the undersigned hereby agrees to pay on demand all sums
then due and all losses or expenses which my be incurred by Lender, including but not limited to reasonable attorneys' fees, without Lender having first or prior
thereto proceeded against borrower.
Signature ____________________________________Printed Name_______________________DATE____________
Witness _____________________________________Printed Name_______________________DATE____________
**General information about your account..**
Any bounced check will have a $25 NSF Fee added into the balance. We do prosecute for uncollected NSF Balances.
WE reserve the right to charge any & all necessary fees involved involved in 3rd party collections or litigation on unpaid balances.
Accounts are periodicaly reviewed for payment patterns, as well as increases & decreases in credit terms & limits.
Applicant authorizes release of above information or attached reference list to Linc Systems Inc.
(Please sign below to authorise release & accept account terms & conditions as listed above)
**Signature __________________________________Printed Name_______________________DATE____________
Remit To address: Linc Systems
PAGE 2 of 2 PO BOX 1627
rev 1.4 03-21-08 Indianapolis, IN 46206-1627
**General information about your account..**
Any bounced check will have a $25 NSF Fee added into the balance. We do prosecute for uncollected NSF Balances.
WE reserve the right to charge any & all necessary fees involved involved in 3rd party collections or litigation on unpaid balances.
Accounts are periodicaly reviewed for payment patterns, as well as increases & decreases in credit terms & limits.


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