Lewis Machine Co., Inc. 808 Center Ave. Clanton, Alabama 35045 Phone: (205)755-4372 Fax: (205) 755-4374 Toll Free: (800) 545-4343 Specializing in Repair Parts & Machinery Building CONFIDENTIAL APPLICATION FOR CREDIT Date: Firm Name: Billing Address: City: State: Zip: Delivery Address: Type Company: Corporation Partnership Proprietorship If Corporation, State: Year: Officers, Partners or Proprietor Name and Title Name and Title Year Business was Organized: Business Description: BANKS: Name, Branch complete address, and account number: Trade References: Name, Complete Mailing Address, Telephone Number & Account Number: Estimated Credit Line Desired: per month The undersigned agrees to pay all penalties, service charges, reasonable attorney and court costs/ fees incurred in the collection of their past due account, to the maximum amount allowed by law. Legal name of Firm: Authorized by (Officer):
Name and Title
Year Business was Organized:
Business Description:
The undersigned agrees to pay all penalties, service charges, reasonable attorney and court costs/ fees incurred in the collection of their past due account, to the maximum amount allowed by law.
Authorized by (Officer):