*Name of Firm or Business
Billing Address    
*Street
 
*City                         *State 
 *Zip
Shipping Address 
*Street
 
*City                   *State     
  		  *Zip
*Years at this Address
*Phone                                       *Fax
Accounts Payable Contact  
*Phone 
 *Email *Fax
   
*Ownership
Corporation        Partnership       Individual
*Name(s) of Principal(s)
1. Phone
2. Phone
3. Phone
*References
Name and address of Businesses you have open credit accounts with:
1. Phone
Fax

2. Phone
Fax

3. Phone
Fax
Persons authorized to order and sign for goods and services:
Klingaman's credit terms are net 30 days from the date printed on the Invoice. Invoices not paid within (30) days, shall be subject to a 1.5 percent per month finance charge effective as of the date of invoice. In the event it is necessary to commence collection proceedings, buyer shall pay all collection costs incurred, including any and all fees. Returned checks carry a ($20.00) handling charge.

By including your name:   and Initial here you certify that all information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of exteded credit. This will serve as a personal guarantee payment of all goods and or services ordered and received.

 Please complete one or the other:

*Social Security Number:
*Fed. Tax ID Number:


*Required fields