Business Credit Application

Business Information
Business Name*
Business Address*
Street Address Address Line 2 City State ZIP Code
Is your business address the same as your site address?*
- Yes
- No
Site Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
FEIN*
Is your entity tax exempt?*
- Yes*
- No
*If exempt, please upload your exemption certificate.
NOTE: All invoices subject to taxation will be charged sales tax unless appropriate documentation is provided.
DBA

Ownership
Business Classification*
- Incorporation
- LLC / LLP
- Proprietorship / Partnership
- Government
- Non-Profit
If incorporated, date of incorporation:
State of Incorporation*
Principle Owners, Officers, and Partners
Principle #1*
First Name Last Name
Title*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Principle #2
First Name Last Name
Title
Phone
Address
Street Address Address Line 2 City State ZIP Code
Social Security Number
Please enter a number from 100000000 to 999999999.
Authorized Buyer(s)

Preferred Payment Method
Preferred Payment Method*
- Payment by check: (Remittance; Lippert Mechanical 1600 N. Topping Ave. Kansas City, MO 64120)
- Payment by ACH: (A member of our accounting team will reach out and provide the necessary information to the designated member of your team)
- Payment by credit card: (All credit card payments will be assessed a 3% transaction fee)

Accounts Payable Contact
AP Contact*
First Name Last Name
Title*
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
PO Required?*
- Yes
- No
Invoice Delivery Method*
- Email - Listed above
- Email - Different from above
- Mail - Listed above
- Mail - Different from above
AP Email*
AP Address*
Street Address Address Line 2 City State ZIP Code

Trade References
Give ONLY names of those you buy from on OPEN ACCOUNT. References WILL NOT be considered valid unless full names and addresses are included.
Company #1 Name*
Account #
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Company #2 Name*
Account #
Phone*
Address*
Street Address Address Line 2 City State ZIP Code

Acknowledgement
To the best of our knowledge and belief, the information provided is accurate and may be relied upon in making your credit decision. We authorize our bank and suppliers to furnish you any information necessary to complete your evaluation of our credit history.

Applicant's signature attests financial authority, responsibility, ability, and willingness to pay our invoices in accordance with our standard terms and conditions.

Any invoice not paid within 45 days will be considered in default incurring 1.5% finance charge and subject to C.O.D. terms. Any billing questions must be brought to our attention within five (5) business days from receipt of invoice. The undersigned agrees to pay any and all costs associated with the collection of any bills, if collection becomes necessary.
Signature*
Your Name*
First Last
Title*
Date*
Date Format: MM slash DD slash YYYY
Who is your North Point salesperson?*
Comments
This field is for validation purposes and should be left unchanged.

Business Information