Fine Hardwood Lumber and Wood Products
2197 Hwy. 26, Watertown, WI 53098
1.920.261.1831  Fax: 1.920.261.1905  1.888.261.1888
www.hansonleja.com   sales@hansonleja.com

ON- LINE FORMS - Credit Application
Date:
Complete Legal Name:
Street Address:
City: County: State or Prov.:
Zip/Postal Code: Country:
Billing Address:
Telephone #: Ext. Fax #:
Business Structure: Federal ID#:
Description of Business: # of Employ:
Yr Bus. Started: Yr Bus. Inc: Annual Sales $:
Bank Reference:
Name: Contact: Acct #:
Mailing Address: Telephone #:
List Principal Owner(s), Corporate Officers or Partners:
Name
Title
Since
Mailing Address
c/o ownership:
c/o ownership:
c/o ownership:
Trade References: ALL three spaces must be filled in with current open account creditors that allow your firm to purchase $1,000.00 or more, within the last 12 months.
Firm Name:
Contact: Mailing Address:

Fax:

Address:
City:
State/Prov/Country:
 Zip:
Firm Name:
Contact: Mailing Address: Fax:
Address:
City:
State/Prov/Country:
Zip:
Firm Name:
Contact: Mailing Address: Fax:
Address:
City:
State/Prov/Country:
Zip:
Accounts Payable Contact:
Purchasing Procedures
Purchase Orders Issued:
If so, who issues:
Name: Title:
Name: Title:
Name: Title:
Sales Tax Status: (If Not Taxable, Please Provide a Copy of Your Blanket Tax Certificate)
Taxable: Sales Tax Certificate:
Estimated Monthly Credit Reqmts ($): DUNS#:
In consideration of Hanson & Leja Lumber Company extending credit to me/us, I/we agree to be bound by these terms of credit. I/we do hereby certify that all statements made in this credit application are true and correct and that such statements have been made for the purpose of inducing Hanson & Leja Lumber Company to sell merchandise/service to me/us on credit. I/we do hereby guarantee and bind ourselves to the faithful performance of all obligations under this agreement including the timely making of all payments due on our account with Hanson & Leja. If credit is being extended to a corporation in which I/we are an officer, director, or shareholder, I/we do hereby bind not only the corporation but also do hereby personally guarantee the performance of the corporation of all its obligations under this agreement including the personal guarantee of payment of any and all sums due to Hanson & Leja Lumber Company by the corporation. Furthermore, the corporation, as well as I/we individually, guarantees the performance by any other person, firm or corporation to whom Hanson & Leja Lumber Company extends credit for me/our behalf. If at any time after the execution of the application in the purchase of materials/services, the terms hereof shall apply to each such account.

I/we acknowledge that purchases on account indicate acceptance of the terms and conditions contained herein and that this application must be approved before any orders are processed. I/we also agree to the following terms and conditions:
 
Applicant Name: Title: Date:
Email Address:
Additional Information to assist us in your request:




© Copyright 2001 by Hanson & Leja Lumber Company & Web Centers of America, Inc.