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Credit Application (Page 1 of 2)

Kilpatrick Irrigation Supply Company, Inc. d/b/a Boynton Pump & Irrigation Supply
Kilpatrick Turf Equipment, Inc. / Kilpatrick International Sales Co.
7700 High Ridge Road, Boynton Beach, FL 33426 / Tel: (561) 533-1450 / Fax: (561) 533-1510

Date

Store / Department / Salesperson

Applicant

Legal Company Name
Operating Name
Street Address
City
County
State
Zip
Phone
Billing Address
Fax

Style of Business Corporation
Partnership
Proprietorship

Year Established
Business Type
Federal Tax ID #
Sales Tax Exempt #
Credit Amount Desired

Officers
Note: Any of the below are authorized to obligate, sign for and pick up materials on behalf of the Applicant.

President
Vice President
Secretary
Treasurer
Other

Trade Reference # 1

Name
Street Address
City
Zip Code
Phone
Fax

Trade Reference # 2

Name
Street Address
City
Zip Code
Phone
Fax

Trade Reference # 3

Name
Street Address
City
Zip Code
Phone
Fax

Bank References

Name
Street Address
City
Zip Code
Account Number
Contact Person
Phone Number

Applicant hereby agrees to pay and indemnify The Kilpatrick Company, Inc. and/or its operating subsidiaries for all costs and expenses it may occur to enforce collection of any amount due under this contract and should any past due bill be placed in the hands of an attorney for collection, applicant agrees to pay reasonable attorney fees and all other costs and expenses incurred in such collection.

This application is for the purpose of opening an account with The Kilpatrick Company, Inc. and/or its operating subsidiaries and to authorize The Kilpatrick Company, Inc. and/or its subsidiaries to check trade and bank references as noted herein and as further necessary to reach a decision on this application.

Email Address