New Customer Signup

Thank you for choosing Stukel Mountain!

Please complete the following form so we may build your account in our systems.

Company Name

Contact First Name

First Name

Contact Last Name

Last Name

Email Address

Email

Office Phone

phone

Cell Phone

Cell

Billing Address

Address

City

State

State...

Zip Code

Physical Address

Physical Address

City

State

State...

Zip Code

Type of Business

Please check... Corporation Please check... Partnership Please check... Sole Proprietor Please check... LLC Please check... Other: Other

Has Ownership Changed in the Past Year? Please check... Yes Please check... No

Years in Business? Please enter information...

Freight Payment Schedule: Net Please enter information... Days

Are you current? Please check... Yes Please check... No

Tell us about your shipments:

Tell us about what you're shipping.

Accounting Information:

Contact First Name

Please enter information...

Contact Last Name

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Phone #

Please enter information...

Email Address

Please enter information...

Invoicing Requirements

Please enter information...

Trade References:

Company Name

Please enter information...

City
city
State
State...
Phone
phone
Email
email

2. Company Name

Company

City
city
State
State...
Phone
phone
Email
email

3. Company Name

Company

City
city
State
State...
Phone
phone
Email
email

Terms & Conditions:

The applicant(s) executing this Application and Agreement (*Customer*) hereby agree(s) that payment forall services is subject to the following terms and conditions:
1. Customer agrees that all amounts due for services provided by “Stukel Mountain, LLC”
and/or any of its subsidiaries or affiliates, (collectively the “Company) are payable at Stukel Mountain, LLC 2700 Washburn Way, Suite B-2, Klamath Falls, OR 97603
2. Customer agrees that all amounts due are not payable in installments, but are payable (Net 15)
days from date of invoice. Company reserves the right to demand payment of all past due freightcharges as a precondition for releasing any shipment(s) at destination. This right includes theright to demand payment upon delivery of shipment(s) at any time. If any amount due is not paidwithin said period, a delinquency charge of 5% per month of the delinquent balance shall beadded to the sum due.
3. In the event the Account becomes delinquent and is turned over for collection, Customer agrees
to pay all costs of collection including reasonable attorney fees and court costs. It is agreed thatcustomer will become C.O.D if customer fails to pay terms.
4. Customer agrees to notify Company by certified mail of any changes in ownership of Customer
and further agrees to be liable for all losses incurred as a result of failure to comply with saidnotifications.
5. Customer authorizes the Company and/or its Credit Agency(s) to investigate all credit history,
bank reference and any other information required to process this application and as it deemsnecessary in the future.
6. Person accepting this document is an authorized representative and has authority to execute this
document.