Credit Application

Nelsen Steel & Wire LP
9400 W. Belmont Avenue
Franklin Park, Illinois 60131

Credit Dept Contact: Joanne Fonseca
Phone: (847) 671-9700 ext. 274
Fax: (847) 671-9775
E-mail:

Credit App

Application For Credit – downloadable PDF The Company described below ("Applicant") hereby applies to Nelsen Steel & Wire L.P. ("Nelsen Steel") for the extension of credit in connection with purchases from Nelsen Steel:


COMPANY INFORMATION

* Required
Business Name:*
Other D.B.As:
Billing Address:*
City:*

State:*

Zip Code:*

Shipping Address (if different from above):
City:

State:

Zip Code:

Business Phone:*

Business Fax:*

Federal Tax ID Number:*

Resale Certificate No:*

Amount of Credit Line Requested:*

Anticipated Monthly Purchases:*

Type of Business (Check all that apply):*	Screw Machine Prod Service Center Appliance Mfg. Broker/Reseller Automotive Farm/Construction
If other type of business (explain):
Type of Company:*	Corporation Partnership Sole-Proprietorship
Date Business Commenced:*

Size of this location:*

How long at this location:*

Rent or Own?*	Rent Own
Number of Employees at this location:*

CONTACT INFORMATION

President
Name:*
Phone Number:*
Fax Number:*
Email:*

CFO/Controller
Name:*
Phone Number:*
Fax Number:*
Email:*

Buyer
Name:*
Phone Number:*
Fax Number:*
Email:*

Accounts Payable
Name:*
Phone Number:*
Fax Number:*
Email:*

BANK REFERENCES

Please identify a financial institution where the Applicant currently maintains an account and which may becontacted by Nelsen Steel for a reference:

Name of Financial Institution:*
Address of Financial Institution:*
City:*

State:*

Zip Code:*

Contact Person:*

Contact Phone Number:*

Contact Fax Number:*

Account Number:*

Type of Account:*


“I hereby authorize the release of any and all information requested by Nelsen Steel & Wire L.P. in conjunction with my application for credit.”

Applicants’ Signature:*
(Must be a signer at the Bank)

Date:*

Company Name:*

TRADE REFERENCES

Please provide a minimum of three unrelated businesses which are currently providing credit to the
Applicant and which may be contacted by Nelsen Steel for a reference.


Name:*
Address:*
City, State:*
Account #:*

Name:*
Address:*
City, State:*
Account #:*

Name:*
Address:*
City, State:*
Account #:*

Name:
Address:
City, State:
Account #:


Telephone:*
Fax:*
Zip Code:*
Terms:*

Telephone:*
Fax:*
Zip Code:*
Terms:*

Telephone:*
Fax:*
Zip Code:*
Terms:*

Telephone:
Fax:
Zip Code:
Terms:

In consideration of any credit which may be extended to applicant by Nelsen Steel, Applicant hereby agrees to the following:

1. If any credit is extended to applicant by Nelsen Steel, all such amounts will be done and payable thirty (30) days following the date of the applicants’ invoice. Any amount which is not paid when due shall bear interest from such due date at the rate of one and one-half percent (1 ½%) per month until paid in full.

2. Applicant agrees to indemnify and hold Nelsen Steel & Wire L.P. harmless from and against any and all loss, cost, damage, liability and expense (including without limitation attorneys’ fees) which Nelsen Steel & Wire L.P. may suffer or incur as a result of any failure by Applicant to pay to Nelsen any amount when due.

3. Applicant agrees to the release of any and all information requested by Nelsen Steel & Wire L.P. in conjunction with this application for credit.

Applicants’ Signature:*

Title:*

Company Name:*

Date:*

Enter the validation code:

Enter the code

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