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502-585-2381
1450 Mellwood Ave. Louisville, KY 40206
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Home
Catalog
About
Suppliers
Resources
Janitorial Equipment
Equipment Repair
Used Equipment
Tennant R14 Rider Carpet Cleaner 28
Inventory Control
Green Cleaning Supplies
Floor Scrubbers
Video Library
MSDS/SDS Info
Credit Application
News
Contact
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Credit Application
Fill out the form below, and our team will contact you within 1–2 business days.
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Type of Account
Type of Account Requested
(Required)
Net 30 Days
COD
Credit Card (Visa, MasterCard, or Discover)
Business Information
Business Name
(Required)
Date
(Required)
MM slash DD slash YYYY
Billing Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Ship to Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Contact Information
Purchasing/Buyer Contact Name
(Required)
First
Last
Purchasing/Buyer Phone
(Required)
Purchasing/Buyer Email
Accounts Payable Contact Name
First
Last
Accounts Payable Phone
Accounts Payable Email
Fax Number
Business Ownership
Business Ownership
(Required)
Corporation
Partnership
Proprietorship
Federal Tax ID # (EIN)
(Required)
Type of Business
(Required)
Years in Business
(Required)
Owners/Officers
Owner 1 Name
(Required)
First
Last
Owner 1 Title
Owner 1 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Owner 2 Name
First
Last
Owner 2 Title
Owner 2 Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Banking
Bank Name
(Required)
Bank Phone
Bank Email
Bank City/State
City
State / Province / Region
Checking #
Loan Account #
Trade Resources
Supplier 1 Company Name
(Required)
Supplier 1 Name
(Required)
First
Last
Supplier 1 Phone
(Required)
Supplier 1 Email
(Required)
Supplier 1 Account #
Supplier 1 EIN
Supplier 2 Company Name
(Required)
Supplier 2 Name
(Required)
First
Last
Supplier 2 Phone
(Required)
Supplier 2 Email
(Required)
Supplier 2 Account #
Supplier 2 EIN
Supplier 3 Company Name
(Required)
Supplier 3 Name
(Required)
First
Last
Supplier 3 Phone
(Required)
Supplier 3 Email
(Required)
Supplier 3 Account #
Supplier 3 EIN
Agreement & Terms
I certify that the above information is correct and I authorize the creditors listed above to provide credit information to Leonard Brush & Chemical Co. I further authorize Leonard Brush & Chemical Co. to check my personal credit, if necessary.
The Undersigned purchaser agrees to pay all past due invoices. In the event it becomes necessary to place this account for collection, purchaser agrees to pay in addition to the principal amounts, service charge interest and other lawful charges, including all costs and expenses of collection, which may include a reasonable attorney's fee of 30%.
Payment terms for open charge accounts are Net 30 Days. All past due invoices over 30 days are subject to a 1½% monthly interest service charge.
Free delivery is available for orders in the greater Louisville, Kentucky area.
Diesel Fuel surcharges may apply.
There is a
$100.00 minimum purchase amount for free delivery.
If the purchaser requests a delivery under the minimum order amount, there will be a service charge up to
$15.00
added to the invoice.
Claims arising from invoices must be made within seven (7) working days.
Our return check fee is $20.00 or an amount equal to the bank charges. All prices are in United States Dollars.
Agreement
(Required)
I agree to the terms and conditions stated above.
Title/Position
(Required)
EIN
Print Full Name
(Required)
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