Credit Application – LGMG North America Inc.

Please download and email ([email protected]) the completed credit application to LGMG for processing and approval

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A credit application can also be completed and submitted below:

Credit Application

BUSINESS INFORMATION

Business Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Business Phone *

Business Fax *

AP Contact *

AP Email Address *

Federal Tax ID# *

DUNS# *

Business Type *

Proprietorship
Corporation
Partnership
Other

Nature of Business *

No. of Employees *

Years in Business *

Purchase Order Required? *

Restrictions on Who May Use your Account? *

PRINCIPAL OWNERS OR OFFICERS

Name *

First

Last

Title *

Tax ID or SS Number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name (2nd)

First

Last

Title (2nd)

Tax ID or SS Number (2nd)

Address (2nd)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name (3rd)

First

Last

Title (3rd)

Tax ID or SS Number (3rd)

Address (3rd)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

BANKING INFORMATION

Bank Name *

Bank Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Account Number *

Bank Contact *

First

Last

Bank Phone *

Bank Fax *

TRADE REFERENCES

Business Name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact *

First

Last

Phone *

Fax *

Business Name (2nd) *

Address (2nd) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name (2nd) *

First

Last

Phone (2nd) *

Fax (2nd) *

Business Name (3rd) *

Address (3rd) *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Name (3rd) *

First

Last

Phone (3rd) *

Fax (3rd) *