King Industries Inc. Telephone 1-800-506-5464

Account Application

Ship To:      St. Address: 

City:      State:      Zip:      County: 

Contact Person:      Telephone: ( – 

Email: 

Bill To:      St. or Box Address: 

City:      State:      Zip:      Telephone: ( – 

Contact Person: 

Email: 

Vendor References

(List three vendors with whom you have done business with for at least one year. Please do not include
banking references, telephone companies, utility companies, or sanitation companies.)

1.

Name:      Address:      City: 

State:      Zip:      Phone: ( –      Fax: ( –      Account Number: 

2.

Name:      Address:      City: 

State:      Zip:      Phone: ( –      Fax: ( –      Account Number: 

3.

Name:      Address:      City: 

State:      Zip:      Phone: ( –      Fax: ( –      Account Number: 

Please check which business entity that your company is operating under:

Corporation     Partnership     Individual Proprietor*

State of Incorporation / Partnership: 

Principal Owners

Name:      Address:      Phone: ( – 

Name:      Address:      Phone: ( – 

Name:      Address:      Phone: ( – 

I Hereby Authorize All Companies, " Agencies As Shown On This Application To Release Business Credit Information To King Industries, Inc.

          
Signature / Print NameTitleDate

*CREDIT RELEASE REQUIRED FOR INDIVIDUAL PROPRIETORS

By signing this document, I hereby acknowledge that I am the owner and am authorized to sign on behalf of the above entity.  I further agree that I shall personally guarantee payment of all charges due and owing King Industries, Inc. including any and all costs of collections, and reasonable attorney’s fees in the event of litigation arising from unpaid debts.  I further agree that this document shall be governed by the laws of the State of Kansas.  I also hereby authorize the release of credit information to King Industries Inc. for the purposes of obtaining business credit.

          
Signature / Print NameSocial Security NumberDate


Print and mail to the address shown below - or fax to (888) 481-5464