KMH Systems | Credit Application

Please use the form below in order for us to process your credit application.

*All fields below are required to be filled out in order to process your credit application

1. Customer Information
Exact name of firm or corporation	Telephone Number
Contact	Fax Number
Physcial Address	Billing Address (leave blank if the same)
2. Company Structure
Corporation State	Partnership General Limited	Individual Federal ID#
3. Names Of Principals (required for all proprietors and partnerships and for corporations in business less than 2 years)
1 - Name Social Security # Home Address	2 - Name Social Security # Home Address
Type of business Number of years in business
4. Bank & Secured References (required for all proprietors and partnerships and for corporations in business less than 2 years)
1 - Name Social Security # Home Address	2 - Name Social Security # Home Address
5. Trade References
1 - Company Telephone Number Fax Number Contact	2 - Company Telephone Number Fax Number Contact

3 - Company Telephone Number Fax Number Contact	4 - Company Telephone Number Fax Number Contact
PARTIES HEREBY AGREE THAT ALL PURCHASES MADE ARE SUBJECT TO THE FOLLOWING TERMS AND CONCITIONS... 1. The undersigned purchase hereby agrees to pay service charges on accounts over 31 days old. These service charges will accrue at the rate of 1.5% per month (18% per annum or the maximum allowed by law). 2. The undersigned purchaser agrees to pay, in the event this account becomes delinquent and is turned over to any attorney for collection, reasonable attorneys fees plus all court and attendant collection costs. 3. The parties hereby acknowledge that the goods and/or services purchased are not payable in installments, but are payable in full as stated herein.