Lusk & Associates The Right Parts Right Now

Lusk & Associates is ready to accept American Express, Visa and Mastercard for all purchases.

All first time customers and infrequent customers are required to pay for purchases by credit card.

Repetitive customers or newer customers who expect to purchase goods on a monthly basis may qualify for trade terms. If you believe that you may qualify for trade terms, please complete the application below. Approval of terms will be dependent upon a credit review and a recommendation by your Lusk & Associates Sales Representative. If you have questions, you may contact our credit department at 714-630-3330. *The following fields must be completed in order to process.

Name*
Company*	Title*
Address*	City*	State*	Zip*
Phone*	Fax*	Area Code*
E-Mail*	D&B D-U-N-S Number*

Type of Business
Proprietorship
Partnership
Corporation		State Incorporated

Name* (officers or owner)	Title*
Name (officers or owner)	Title
Name (officers or owner)	Title
Nature of Business*	Annual Sales*

Years in Business*	Number of Locations*
Number of Employees*	Est. Mo. Purchases*

Credit References

Bank Name*

Contact Name*

Bank Address*

City, State, Zip*

Type of Account*

Account Number*

Vendors References

Name*

Contact Name*

Address*

City, State, Zip*

Telephone*

How Long*

Name*

Contact Name*

Address*

City, State, Zip*

Telephone*

How Long*

Name*

Contact Name*

Address*

City, State, Zip*

Telephone*

How Long*

Sales Rep*