Customer Credit Application

Fill out the Credit Application form below completely for credit terms of NET 30.

When completed, hit submit, and it will be automatically sent to Dukes A&W. Incomplete applications may cause delays in approval.

Prefer a paper application? Download the PDF here.

If you have any questions, please call Dukes Accounting at 502-961-0903 extension 307. Thank you.

BILL TO:

First Name *

Last Name *

Company Name *

Street Address *

City

State

ZIP Code

Phone Number *

Fed ID or SS# *

SHIP TO:

First Name *

Last Name *

Company Name *

Street Address *

City

State

ZIP Code

Phone Number *

Resale Tax # *

Attach Sales Tax Certificate here if applicable

No file chosen

Company Classification *CorporationPartnershipIndividual/PropriertorshipSelect one

Owner or Officer Name *

Owner or Officer Title

Name on Check if different than Company name

PO Number Required?YesNoSelect one

Credit Line Requested

Net 30 Account Requested?YesNoSelect one

ACCOUNTS PAYABLE DETAILS

Contact Person First Name *

Contact Person Last Name *

Account Payable Contact Person Email *

Bank Name *

Street Address *

City *

State *

ZIP Code *

15 - 10 =? *Help us prevent spam by answering this simple math problem

References (Three Vendors Required)

Reference 1

First Name *

Last Name *

Email Address *

Full Address *

Reference 2

First Name *

Last Name *

Email Address *

Full Address *

Reference 3

First Name *

Last Name *

Email Address *

Full Address *

CREDIT POLICY AND TERMS OF SALE

Minimum billing amount (excluding freight and taxes) is $10.00
Applicable state sales taxes will be charged until the customer provides a valid executed sales tax exemption certificate.
Invoices are payable net within 30 days from invoice date in United States funds. Finance charges may accrue after that. If an account is Sixty (60) days or more past due the account will be put on COD.
Orders are shipped FOB-Shipping Point, Freight not Allowed, by the most economical carrier possible, unless otherwise specified, in writing.
No material, product, may be returned without prior authorization and a properly obtained RGA number.
Returned materials may be subject to a restocking charge.
Should your account become delinquent and is referred to a collection agency, you will be liable for the collection fees as well as the account balance.
The undersigned hereby personally guarantees' payment of invoices applied to its charge account with Dukes A&W Enterprises, LLC, including finance charges due to the late payment of any invoice. Undersigned also agrees to pay expenses, including reasonable attorney fees, incurred by Dukes A&W in collecting monies owed.

By signing your name in the signature block below you authorize Dukes A&W to contact the references above with any information needed to verify your account, and you agree to Dukes A&W's payment terms listed above.

Signature *

Title

Date *