Customer Credit Application

To apply for customer credit with Dukes A&W, please complete the Credit Application form below in its entirety. This application is required for customers seeking NET 30 credit terms, which allow you to make purchases now and pay the full balance within 30 days of the invoice date. NET 30 terms are a convenient way to streamline your business transactions while maintaining a healthy cash flow.

Once you’ve filled out all the required fields, simply click submit. Your completed form will be automatically sent to the Dukes A&W Accounting Department for processing. Please note that incomplete or inaccurate submissions may result in approval delays, so be sure to double-check your information before submitting.

If you prefer a more traditional method or need a physical copy for your records, you can easily download the PDF version of the application here and submit it manually.

Should you have any questions or require assistance while completing the form, don’t hesitate to reach out. Our Accounting team is happy to help, just give us a call at 502-961-0903, extension 307.

Thank you for choosing Dukes A&W. We appreciate your business and look forward to working with 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 *

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 *

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