Credit Application "*" indicates required fields Company InformationCompany Name* DBA (if different) D-U-N-S Number* Contact Person* Address* Street Address City State Zip Phone*FaxFederal Tax ID* Type of Business* Number of employees*Date business established* MM slash DD slash YYYY Which railroad does this pertain to?*SelectCSS - Chicago South Shore & South BendGCS - Gulf Coast SwitchingLIRC - Louisville & Indiana RailroadNLR - Northern Lines RailwayNYA - New York & Atlantic RailwayPHL - Pacific Harbor LineType of products you will purchase* Amount of credit requested*Are you a corporation?* Yes No State of incorporation*Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificName and title of chief corporate officer 1* Address of chief corporate officer 1* Street Address City State Zip Name and title of chief corporate officer 2* Address of chief corporate officer 2* Street Address City State Zip Name and title of chief corporate officer 3* Address of chief corporate officer 3* Street Address City State Zip Name of your resident agent* Address of your resident agent* Street Address City State Zip PartnershipName of partner* Address of partner* Street Address City State Zip Sole ProprietorshipAre you sales tax exempt?* Yes No Have you ever had credit with us before?* Yes No If yes, under what name? Authorized purchasers* Accounts payable phone*Accounts payable Email* Purchase order required?* Yes No Trade Reference 1Name* Address* Street Address City State Zip Phone*Trade Reference 2Name* Address* Street Address City State Zip Phone*Trade Reference 3Name* Address* Street Address City State Zip Phone*Bank Reference 1Phone*Contact person* Name of bank* Address* Street Address City State Zip Bank Reference 2Phone*Contact person* Name of bank* Address* Street Address City State Zip General Terms and Conditions & Personal Guarantee Bills are sent as railway services are performed and all bills are payable in full 15 days from the billing date. A service charge of 1% per month will be added to all amounts billed if not paid by the 15th day from billing date. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. PERSONAL GUARANTEE: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation. Agreement of Terms and Conditions*I have read the terms and conditions stated above and agree to all of these terms and conditions. Yes Digital SignatureI represent that the above information is true and is given to induce credit to the applicant. My company and I authorize the Louisville & Indiana Railroad to make such credit investigation as sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to the Louisville and Indiana Railroad any and all information concerning the financial and credit history of my company and myself.Name* Title* Date* MM slash DD slash YYYY CAPTCHACheck the box below to help us stop spam.
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