Credit Terms

I understand that with this open account I will have 30 days to pay. A 1% discount is allowed on merchandise if payment is made within 15 days of invoice. Any invoice not paid in full within 30 days will be considered past due and subject to a monthly finance charge of 1.5% (18% annually).

Agree Disagree

Personal/Company Information

Company		Contact Name
Billing Address		Phone
City		Fax
State		E-mail
Zip Code		Website URL
Account No.

References

Please list three (3) other companies with which you have open account privileges. We will be contacting these businesses to evaluate your creditworhtiness. By completing this form you are authorizing us to contact these businesses. All information gathered here will remain confidential. DO NOT include bank or credit card information. (view our privacy policy)

Reference 1	Reference 2	Reference 3
Company Name	Company Name	Company Name
City	City	City
State	State	State
Zip Code	Zip Code	Zip Code
Phone	Phone	Phone
Fax	Fax	Fax

About Your Business

Type of Business: (select one)
Corporation Partnership Proprietorship

Owner 1	Owner 2	Owner 3
Owner's Full Name	Owner's Full Name	Owner's Full Name
Social Security No.	Social Security No.	Social Security No.
Title	Title	Title
Ownership Percentage	Ownership Percentage	Ownership Percentage
Residence Address	Residence Address	Residence Address

Purchase Orders

Do you require the use of purchase order numbers? Yes No

Ship To Address

	Same as Bill-to
Address
City
State
Zip

Legal Stuff

I certify that the information I have provided is try and accurate. I understand that this is a legally binding credit application and that legal action may be taken if I have misreprented myself or my credit history in any way. Yes No

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orderdesk@goodtool-online.com
156 Galewski Drive • Winona, MN 55987 • toll-free: 800-880-7121 • phone: 507-454-1454 • fax: 507-454-1471

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