International New Customer Form

INTERNATIONAL APPLICATION

Dear Prospective Customer:

We appreciate your interest in becoming a customer of NTP-STAG. After submitting your New Customer application, a sales representative will contact you to complete the new customer onboarding process, which is subject to Management review and approval.

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Haga clic aquí para obtener instrucciones en español

Important Information about Becoming a New Customer:

• The New Customer Application must be completed and submitted to our New Account Department.

  • You must purchase merchandise for resale
  • In addition to your completed application, you may also be asked to provide photos of your business, trade references or additional documentation
  • An initial buy-in may be required

If you have any questions, please contact our New Account Department at 1-800-432-8063.

Thank you for your interest in becoming a customer of NTP-STAG.

Thank you,

New Business Development

1-800-432-8063

NewAccountsNTP@lkqcorp.com

Alert Please Choose:


Printable Application [.pdf]




 
 
 

International - Interactive Credit Application

Company Information >> Business Facts >> Billing/Shipping Information >> Trade References >> Bank Reference >> Owner/Officer Comments >> Review/Submit
Fields noted with a red asterik(*) are required information.
Required Pennsylvania Blanket exemption certificate Required California Resale Certificate
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(check all that apply) *  





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Billing Address

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Shipping Address (No P.O. Boxes)

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Please provide three (3) Trade References.
Check here if you are a New Business and DO NOT have Trade References available.

Trade Reference 1

Trade Reference 2

Trade Reference 3

Bank Reference:

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CheckExample
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(Your account ABA routing numbers will help us apply your payments.)
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Primary Officer:

Secondary Officer:

Personal Guarantee Information:

Company Information ( Edit )
Reference Code:
Legal Business Name:
State Sales Tax Number:
Email Address:
D/B/A or Trade Name:
Federal Tax ID Number:
Primary Contact:
Type of Business:
Subsidiary/Franchise:
Parent/Franchise Name:
Dun & Bradstreet #:
Website Address:
Type of Company:
Years at Present Location:
Business Fax Number:
Payment Terms Requested:
Business Phone Number:
Alternate Phone Number:
VAT Number:
Business Facts ( Edit )
Number of Employees:
Annual Revenues:
Expected Monthly Purchase:
Landlord Name:
Landlord Phone Number:
Authorized Buyer:
Buyer Fax Number:
Business Owned Since: /
Rent or Own:
Accounts Payable Contact:
Accounts Payable Phone:
Buyer Phone Number:
Accounts Payable Fax:
Shipping/Billing ( Edit )

Shipping Address

Billing Address

Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
City:
City:
Province:
Province:
Country:
Country:
Postal Code:
Postal Code:
Trade References ( Edit )

Reference 1

Reference 2

Reference 3

Name:
Name:
Name:
Phone:
Phone:
Phone:
Address Line 1:
Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
Address Line 2:
City:
City:
City:
Province:
Province:
Province:
Country:
Country:
Country:
Postal Code:
Postal Code:
Postal Code:
Account Number:
Account Number:
Account Number:
Bank Reference ( Edit )

Bank Reference

Bank Name:
Phone Number:
Address Line 1:
Address Line 2:
City:
Fax Number:
Bank Contact Name:
Account Number:
Province:
ABA Routing Number:
Country:
Postal Code:
Date Account Established:
Type of Business Account:
Owner Officer/Comments ( Edit )

Owner Officer 1

Owner Officer 2

Name:
Name:
Title:
Title:
Phone Number:
Phone Number:
Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
City:
City:
Province:
Province:
Country:
Country:
Postal Code:
Postal Code:
Comments:

Personal Guarantee:

Date: Social Security Number: 

I,       residing at      for and in consideration of your extending credit at my request to (legal name)      (herein after referred to as the “Company”), of which I am (title)   , hereby personally unconditionally guarantee to you, Keystone Automotive Operations Inc., its successors and assigns, at 44 Tunkhannock Avenue, Exeter, PA 18643 payment of any obligation of the Company and I hereby agree to jointly and severally bind myself to pay you on demand any sum which may become due to you by the Company. It is understood that this guaranty shall be continuing in nature and revocable only upon receipt by Keystone Automotive Operations, Inc. of notice of revocation via certified mail. Such revocation shall not apply to existing indebtedness, but only to shipments subsequent to the receipt of such notice. I do hereby agree to be bound by all terms, conditions and covenants set forth in the Application for Credit and Credit Agreement and waive notice of default, dishonor, non-payment, presentment and notice thereof and consent to any modification or renewal or extension of the Application for Credit and Credit Agreement hereby guaranteed. I do further waive any right of indemnification or subrogation which I may have against the Company for any debt arising hereunder.

Terms & Conditions:

APPLICATION FOR CREDIT AND CREDIT AGREEMENT

In order to facilitate timely processing of your order(s), please read and complete this application, sign and return to Keystone Automotive Operations, Inc. along with a copy of your most current, complete financial statement and/or a complete copy of your last fiscal year-end financial statement.

TERMS AND CONDITIONS

1. Any extension of credit by Keystone Automotive Operations, Inc. shall be made solely upon the terms, conditions and policies published by Keystone Automotive Operations, Inc. from time to time. Any modification or amendment thereof shall not be effective unless accepted in writing by Keystone Automotive Operations, Inc. Keystone Automotive Operations, Inc. reserves the right, in its sole discretion, to refuse to extend credit at any time or not to honor any order prior to delivery thereof.

2. The undersigned hereby agrees to pay all invoices from Keystone Automotive Operations, Inc., its successors and assigns, according to the respective terms of sale of each such invoice. In the event that any debt is not paid in accordance with the terms of any invoice between Keystone Automotive Operations, Inc. and the undersigned (“Default’), the entire balance owed by the undersigned to Keystone Automotive Operations, Inc., shall become immediately due and payable at the option of Keystone Automotive Operations, Inc., notwithstanding any other terms of payment. In the event of any such Default, the undersigned shall pay to Keystone Automotive Operations, Inc., interest on the entire outstanding balance due and owing to Keystone Automotive Operations, Inc., by the undersigned at the rate of one and one half (1 1/2 %) percent per month (18% per annum) or at the highest interest rate allowable by law, said interest shall commence and accrue as of the date of the first Default and shall continue until the entire outstanding balance shall be fully paid. Additionally, the undersigned agrees to pay any and all costs and expenses of collection incurred by Keystone Automotive Operations, Inc, with respect to any and all amounts due and owing to Keystone Automotive Operations, Inc. by the undersigned, including, without limitation, reasonable attorney’s fees. All payments received by Keystone Automotive Operations, Inc. shall be first applied to interest, collection costs and expenses, if any, and then to reduce any outstanding debt due and owing.

3. Damaged product, Incorrect Product, Incorrect Pricing, Warranty, or Billing Issues - All Keystone Automotive Operations, Inc. product is deemed accepted after 30 days from Date of the Invoice, unless covered differently under Contractual Agreement. All requests to return product or notification of billing concerns should be directed to the Customer Service Division within this specified time period.

4. This agreement and any disputes arising between Keystone Automotive Operations, Inc., and the undersigned shall be governed by the laws of the State of Pennsylvania and the undersigned hereby expressly waives any and all defenses to the exercise of personal jurisdiction over the undersigned by any state or federal court located in the State of Pennsylvania in any action, suit or proceeding between Keystone Automotive Operations, Inc. and the undersigned arising here under. THE UNDERSIGNED FURTHER KNOWINGLY WAIVES ANY RIGHT WHICH THE UNDERSIGNED MAY HAVE TO A TRIAL BY JURY IN CONNECTION WITH ANY LITIGATION BETWEEN THE UNDERSIGNED AND Keystone Automotive Operations, Inc. BY REASON OF THIS CREDIT APPLICATION AND CREDIT AGREEMENT OR ANY OBLIGATIONS ARISING HEREUNDER. SHOULD ANY PROVISION OF THIS CONTRACT BE FOUND TO BE UNENFORCEABLE, THE REMAINING TERMS AND CONDITIONS WILL CONTINUE TO BE IN EFFECT.

5. The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age; (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Keystone Automotive Operations Inc., Credit Department, 44 Tunkhannock Avenue, Exeter PA 18643, 888-539-7278, within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.

The undersigned is either a sole proprietor, a partner in a partnership, an individual who may be executing a personal guarantee in connection with the extension of credit to Applicant, or one of the principal stockholders of a corporation, I give permission to Keystone Automotive Operations, Inc., to obtain and utilize an individual credit report on me personally to determine my creditworthiness.



By checking this checkbox I understand that I am signing a binding agreement with Keystone Automotive Operations Inc.

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Your application has been successfully submitted, please a copy for your records.

Thank you for your interest in becoming a customer of Keystone Automotive Operations inc.
A representative will be in contact with you to finalize your application.

Company Information
Reference Code:
Legal Business Name:
State Sales Tax Number:
Email Address:
D/B/A or Trade Name:
Federal Tax ID Number:
Primary Contact:
Type of Business:
Subsidiary/Franchise:
Parent/Franchise Name:
Dun & Bradstreet #:
Website Address:
Type of Company:
Years at Present Location:
Business Fax Number:
Payment Terms Requested:
Business Phone Number:
Alternate Phone Number:
Business Facts
Number of Employees:
Annual Revenues:
Expected Monthly Purchase:
Landlord Name:
Landlord Phone Number:
Authorized Buyer:
Buyer Fax Number:
Business Owned Since: /
Rent or Own:
Accounts Payable Contact:
Accounts Payable Phone:
Buyer Phone Number:
Accounts Payable Fax:
Shipping/Billing

Shipping Address

Billing Address

Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
City:
City:
Province:
Province:
Country:
Country:
Postal Code:
Postal Code:
Trade References

Reference 1

Reference 2

Reference 3

Name:
Name:
Name:
Phone:
Phone:
Phone:
Address Line 1:
Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
Address Line 2:
City:
City:
City:
Province:
Province:
Province:
Country:
Country:
Country:
Postal Code:
Postal Code:
Postal Code:
Account Number:
Account Number:
Account Number:
Bank Reference

Bank Reference

Bank Name:
Phone Number:
Address Line 1:
Address Line 2:
City:
Fax Number:
Bank Contact Name:
Account Number:
Province:
ABA Routing Number:
Country:
Postal Code:
Date Account Established:
Type of Business Account:
Owner Officer/Comments

Owner Officer 1

Owner Officer 2

Name:
Name:
Title:
Title:
Phone Number:
Phone Number:
Address Line 1:
Address Line 1:
Address Line 2:
Address Line 2:
City:
City:
Province:
Province:
Country:
Country:
Postal Code:
Postal Code:
Comments:
KeyStone Automotive

Copyright © 2019 NTP-STAG

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