Credit Application

Safety Council of SWLA

Credit Check

Application Form

The Safety Council of Southwest Louisiana offers subscribers the opportunity to be invoiced monthly for employees’ training needs, versus paying at registration for each individual employee. To take advantage of this subscriber benefit, please complete the following credit check application.

If you have any questions, please call our main office.

Please Complete & Digitally Sign the Following Credit Application: Fields marked with “required “ must be filled out to proceed.

Step 1 of 5

Legal Business Name:(Required)

Doing Business As:(Required)

Company Name:(Required)

Contact Person:(Required)

Physical Address:(Required)

Street Address City State ZIP Code

Is Your Mailing Address the Same as Your Physical Address?

Yes

Mailing Address:(Required)

Address City State ZIP Code

Website:

Trade References:

Company Name:(Required)

Contact Person:(Required)

Address

Street Address City State ZIP Code

Phone:(Required)

Fax:(Required)

Email:(Required)

Company Name:(Required)

Contact Person:(Required)

Address(Required)

Street Address City State ZIP Code

Phone:(Required)

Fax:(Required)

Email:(Required)

Company Name:(Required)

Contact Person:(Required)

Address(Required)

Street Address City State ZIP Code

Phone:(Required)

Fax:(Required)

Email:(Required)

The following are requirements for Credit Application Approval:

Credit privilege shall be granted after credit references have been checked.
The company must pay for their first 90 days of services before invoicing is approved.
Applications must be approved by accounting management.

TERMS: All invoices are due and payable on or before thirty (30) days from date of invoice at Safety Council of Southwest Louisiana's ("Safety Council") address, 120 I Ryan St. Lake Charles, LA 7060 I, or at such other address as Safety Council may designate in writing. By signing this agreement, you acknowledge that you intend that Safety Council furnish services to you, including the provision of safety training and certification, in exchange for your promise to pay for said services within thirty (30) days from date of invoice. The information furnished by you is for the purposes of obtaining credit from the Safety Council of Southwest Louisiana and you warrant that said information is correct, complete and true, and that Safety Council is justified in relying on the information furnished by you in determining whether to extend credit to you. You authorize Safety Council to make such inquiries as Safety Council deems necessary or appropriate in determining whether to extend credit. After approval of your credit, if Safety Council determines, in its sole discretion, that you are unable or unwilling to make required payments you acknowledge and agree that Safety Council may elect to terminate this agreement and declare any outstanding balances on your account immediately due and payable.

Failure to pay an invoice within Sixty (60) days of the invoice date will result in the suspension of credit privileges, training classes and services including the issuances of badges and certification. In addition, if you fail to pay an invoice within Sixty (60) days of the invoice date, you acknowledge and agree that Safety Council may elect to notify any person or entity that that Safety Council has suspended services, including the provision of safety training and certification, on your account for failure to remit payment timely. Failure to pay an invoice within Ninety (90) days of the invoice date will result in the institution of legal proceedings against you. Tf Safety Council brings an action against you to collect any outstanding balances or to enforce any provision hereof, Safety Council shall be entitled, in addition to any other rights or remedies available to it, to collect from you the reasonable costs and expenses incurred in the investigation preceding such action and the prosecution of such action, including but not limited to reasonable attorney's fees, expenses and court costs. You agree that the exclusive jurisdiction and venue for any disputes arising hereunder shall be the 14th Judicial District Court, Calcasieu Parish, Louisiana, or the Federal District Court, Western District of Louisiana, Lake Charles Division. By signing below, you certify that the signatory is authorized to incur liabilities and to execute this document.

Company:(Required)

Date:(Required)

Signature:(Required)

Title:(Required)

Please Type Your Name:(Required)

Credit Check

Application Form

The Safety Council of Southwest Louisiana offers subscribers the opportunity to be invoiced monthly for employees’ training needs, versus paying at registration for each individual employee.

To take advantage of this subscriber benefit, please complete the following credit check application.

If you have any questions, please call our main office.

We will be closed for Labor Day, Monday, September 4th.

Safety Council of SWLA