New Customer Campaign

New Customer 50th Credit Application Form

Thank you for your interest in our business. We strive to fulfill all of your laundry equipment needs. In order that we may establish an open line of credit for your company, please furnish the following requested information. A valid Credit Card is required as a backup payment method.*

Business Legal Name:(Required)

Phone(Required)

Email(Required)

Bill to Address:(Required)

Street Address Address Line 2 City State ZIP Code

Which sales rep referred you?(Required)

DBA:(Required)

Ship to Address:(Required)

Street Address Address Line 2 City State ZIP Code

Payment Method(Required)

ACH

Credit Card

ACH Payment Authorization

I authorize Southeastern Laundry Equipment to debit the bank account indicated below for payment of my obligations. The transaction will appear on your bank statement under Southeastern Laundry Equipment. Please attach a copy of a voided check.

Account Type

Bank Name:(Required)

Account Number:(Required)

Bank Routing Number:(Required)

Bank Name:(Required)

ACH Authorization Agreement

I understand and agree that any and all changes in my account information must be in writing and delivered to Southeastern Laundry Equipment at least 21 days prior to the next due date. If the payment due date falls on a weekend or holiday, the payment may be executed on the next business day. Adequate funds must be available for withdrawal from my account by the payment due date. In the case of an ACH transaction being rejected for Non Sufficient Funds (NSF), submission error, or other bank related return reasons, Southeastern Laundry Equipment may at its discretion resubmit the ACH debit transaction within thirty (30) days. A return item charge may be assessed for each returned ACH debit.

Print:(Required)

Signature(Required)

Today's date(Required)

Credit Card Payment Authorization

I authorize Southeastern Laundry Equipment to charge the credit card indicated below for payment of my obligations. The transaction will appear on your card statement under Southeastern Laundry Equipment. Please notify us at least 21 days in advance of any changes to your credit card information, or immediately if the card has been compromised.

Name on Card(Required)

Billing Address (Street, City, State)(Required)

Billing ZIP Code(Required)

Cardholder's Phone Number(Required)

Cardholder's Relationship to Company(Required)

Credit Card Number(Required)

Credit Card Expiration Date (MM/YY)(Required)

Card CVV(Required)

Print:(Required)

Signature(Required)

Today's date (MM/DD/YYYY)(Required)

CAPTCHA

Locations

Industrial (OPL)

Find Your Location

Laundromat

Find Your Location

Find Your Local Sales Rep

Service

Request service now

Call us now

Locations

Industrial (OPL)

Find Your Location

Laundromat

Find Your Location

Find Your Local Sales Rep

Service

Request service now

Call us now

New Customer 50th Credit Application Form

ACH Payment Authorization

ACH Authorization Agreement

Credit Card Payment Authorization