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Confidential Account Application

Please fill out this application completely and submit.

General Business Information (Complete all fields.)

(Required if a Corporation)

Type of Business:
President or Owner Name
Primary Contact Name (responsible for purchasing)
Accounts Payable Contact (Complete all fields)
Payment Methods Available

Customer hereby agrees to pay all purchases from QLS Lubricants upon delivery, or on such other terms as may be offered subsequently by QLS Lubricants, in writing. All accounts past due thirty-days are subject to a 1.5% late fee, per month. Customer hereby agrees to pay any such fees that are incurred. Customer agrees to pay any reasonable attorney’s fees and costs, or any other costs incurred by QLS Lubricants in connection with collection of past due amounts for purchases by customer from QLS Lubricants. In the event customer is a corporation, the undersigned individual hereby acknowledges a personal guarantee of all obligations to QLS Lubricants. Customer hereby acknowledges that QLS Lubricants retains a security interest in all products until charges are paid in full.

Signature of Authorized Owner, Partner or Corporate Officer Required.

MM slash DD slash YYYY
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