2026 KPMI Full Catalog V1 - Flipbook - Page 369
KPMI DEALER APPLICATION
®
•
Kibblewhite® Precision Machining,
Inc.
Dealer / Credit Application
PageAPPLICATION
1 of 2
Application cannot be considered unless the owner, partner, or a corporate officer signs it.
Company Name_
Street Address
Attn:
Phone #
Type of Business
Partnership
please check one:
Speed Shop
Principal/Owner(s) Name
Address
Soc. Sec#
Fed. ID#
Tres/Controller
City
County
Fax#
Sole Proprietor
LLC
Machine Shop
Parts Store / Warehouse
Corporation
Resale#
State
Zip
Country
E-Mail_
Date Business Started
_
_
Other
Title
Phone Number
City
State
Zip
WA Contractor #
Expires
Years in business under this ownership, at this location_
_
If in business less than one year, please submit prior business work history.
Name of Bank
Branch
Address
City
Years at this bank
Account#
Trade References: Please list two firms within the industry and one firm outside the industry.
1. Company
Phone
Address
City
2. Company
Address
3. Company
Address
Please indicate the type of account required
Phone __________
State
Zip
Fax
Zip
State
Phone
City
State
Fax
Phone
City
State
Zip
Fax
Zip
C.O.D. (Co check OK - A credit inquiry is required. Please allow 2-weeks for credit inquiry processing.) or
Credit
Card account with KIBBLEWHITE PRECISION MACHINING INC. I understand that all account balances are payable to KIBBLEWHITE PRECISION MACHINING, Inc. at the address
specified on invoices or statements. I also understand that interest will be charged on past due balances at a rate not to exceed the applicable legal maximum.
Handling Fees: Handling fees may apply to all shipments. You will be informed if your shipments will incur a handling fee. Additional Fees: Drop-ship $15.00 / Wire transfer $20.00.
If establishing a credit card account please indicate the following:
Type of card
Signature
Title
Card Number
Printed
Exp. Date
Date
Please provide at least two of the following:
Copy of your business license
Copy of your state sales tax certificate
Copy of an ad from any trade Magazine
Copy of Yellow Pages ad
Applicant’s Authorization & Agreement
In support of this application KIBBLEWHITE PRECISION MACHINING INC. is hereby authorized to obtain credit and/or financial information from my/our bank(s), other
financial institutions or commercial firms with whom I/we have done business. It is understood that any such credit and/or financial information will be held in strict confidence
and used only in consideration of this application.
Upon approval of this application, it is agreed that each invoice will be paid in full upon receipt or in accordance with the terms of sale as stated on the invoices(s). Should I/we
not pay KIBBLEWHITE PRECISION MACHINING INC. according to term, it is understood that credit privileges may be withdrawn. Should KIBBLEWHITE PRECISION
MACHINING INC. find it necessary to obtain assistance in collecting any past due balance, I/we agree to pay interest at the rate of 1.5% per month (or such other rate
allowable by State law), reasonable attorney fees, collection fees and/or court costs allowable by law. At KIBBLEWHITE PRECISION MACHINING INC. option, jurisdiction and
venue of any suit brought to collect this account shall be had in San Mateo County, CA. A copy of this statement and application has been received.
SIGNATURE
TITLE
_
Fax
(must be signed by an officer or principal of the firm)
PERSONAL GUARANTEE
The undersigned, [print name]
, of the applicant corporation/company hereby agrees to the above terms and conditions and
assumes personal responsibility for payment of said corporation’s/company’s account. It is understood that credit would not be extended to said
corporation/company without this assumption of liability.
CREDIT DEPARTMENT USE ONLY
999-400100
TERMS CODE
CREDIT LIMIT
DATE
6/22/2017
351
CUSTOMER#
CREDIT MANAGER SIGNATURE
(owner, partner or corporate officer)
Rev. 3
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