US New Customer Form

UNITED STATES 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.

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.
  • You must provide us with your state sales tax number and a copy of your state resale certificate or exemption certificate.
  • 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.
  • For information on our Dropshipping program, click here!

Click here to view our supplier line card. 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

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United States - Interactive Credit Application

Customer Application >> Credit Application >> Terms & Conditions >> Documents References >> Submit >> Review/Submit
Fields noted with a red asterik(*) are required information.
*This section of the application is intended for creating a customer account with Keystone Automotive Operations.
If you would like to apply for any Terms other than Prepaid Credit Card, please complete the Credit Information Section Best viewed using Google Chrome
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Required Pennsylvania Blanket exemption certificate Required California Resale Certificate

COMPANY INFORMATION

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GENERAL BUSINESS INFORMATION

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GENERAL BUSINESS INFORMATION - Continued

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Must attach tax exempt certificate

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EXPORT COMPLIANCE

LKQ CORPORATION NEW CUSTOMER EXPORT COMPLIANCE QUESTIONNAIRE

LKQ Corporation is committed to complying with all export laws of the United States. In furtherance of that goal, we require customers to complete this questionnaire. We will treat the responses as confidential and disclose them only as required by law. Please respond fully to each question and mark any portion which you feel does not apply as not applicable or N/A. Regretfully, we are unable to transact business with you if you do not respond.

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EXPORT COMPLIANCE - Continued

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I hereby certify that all of the above information is true to the best of my knowledge. If any of the above information changes, the Company will immediately notify LKQ Corporation in writing.

OWNERSHIP

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HISTORY

Information provided in the Credit Application Section will be used by LKQ Corporation and/or one of its subsidiaries or affiliates (“LKQ”) solely for the purpose of extending credit. Attach a separate sheet with additional information if necessary.

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BANK REFERENCE

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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

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Trade Reference 2

Trade Reference 3

Company Information ( Edit )
Reason for Account Application (select one):
How did you hear about us? / Reference Code (if applicable) :
Payment Terms Requested:
Payment Terms Requested:
General Business Information ( Edit )
Business Name (Full Legal Name):
D/B/A or Trade Name (if any):

Shipping Address

Billing Address

Shipping Address:
Address:
Shipping Address Line 2:
Address Line 2:
Shipping Address City:
City:
State: AL
State: AL
Zip / Postal Code:
Zip / Postal Code:
Primary Contact:
Primary Contact:
Email Address:
Secondary Address:
Website Address:
Business Type:
Federal Tax ID Number:
Sales Tax Exemption #:
Annual Revenues:
Expected Monthly Purchase:
Number of Employees:
Number of Install Bays:
Number of Install Bays:
Primary Business Focus:
Authorized Buyer Name(s):
Authorized Buyer Phone #:
Authorized Buyer Fax #:
Authorized Buyer Email:
Accounts Payable Contact:
Accounts Payable Phone:
Accounts Payable Fax:
Ownership ( Edit )
Ownership :

Ownership 1

Ownership 2

Name of Principal(s):
Name of Principal(s):
Title:
Title:
Phone:
Phone:
% of Ownership:
% of Ownership:
History ( Edit )
Facilities:
Business Owned Since: /
Number of Years at Present Location:
Have You Ever Filed for Bankruptcy?:
Is your Business a Franchise?:
Bank Reference ( Edit )
Business Account Type:
Bank Name:
Address:
Address Line 2:
City:
State: AL
Zip / Postal Code:
Account Manager to Contact:
Email :
Fax Number:
Phone Number:
Date Account Established: /
Trade References ( Edit )

Reference 1

Reference 2

Reference 3

Business Name:
Business Name:
Business Name:
Contact Name:
Contact Name:
Contact Name:
Phone:
Phone:
Phone:
Fax:
Fax:
Fax:
Email:
Email:
Email:

PERSONAL GUARANTEE

To induce LKQ to extend credit to the above Applicant, the undersigned (“Guarantor”), hereby guarantees payment of any and all of Applicant’s indebtedness to LKQ under this credit agreement or otherwise under applicable law. Any revocation of Applicant’s credit privileges shall not affect the guaranty with respect to amounts owed before receipt of the notice of revocation by LKQ. Notices of acceptance, default and nonpayment are hereby waived. This guaranty shall be a continuing and irrevocable guaranty and indemnity for indebtedness of Applicant to LKQ. Guarantor consents to any modification, extension and/or renewal of the credit agreement hereby guaranteed without notice. If the Applicant fails to pay the account when due, LKQ may proceed against Guarantor to collect any and all amounts due from Applicant, without notice to Guarantor and without first proceeding against Applicant. Guarantor agrees that the laws of the State of Illinois shall govern this credit agreement and guaranty, and that any and all disputes arising from or related to this agreement or guaranty shall be litigated exclusively in state or federal court located in Chicago, Illinois, to whose jurisdiction Guarantor irrevocably consents.

By checking this box, I understand and agree to the Personal Guarantee.

TERMS & CONDITIONS

With its signature below, Applicant (i) certifies that all information contained herein is true and correct and that it is engaged in a commercial activity, (ii) grants permission to LKQ Corporation and its subsidiaries (collectively, “LKQ”) to obtain independent credit reports or credit reports and other information from its references and bank, (iii) authorizes the credit references and bank reference(s) to release information to LKQ that may be used to determine credit worthiness, and (iv) agrees to pay all bills, invoices, and account statements rendered in full within ten (10) calendar days after receipt by Applicant. Any past due account is subject to being placed on collect-on-delivery (C.O.D.) until paid in full. Repeated late payments could result in revocation of Applicant’s credit privileges, which LKQ may revoke in its sole and absolute discretion. Applicant agrees to pay a service charge of 2.0% per month on balances not timely paid. Applicant also agrees to pay all of LKQ’s reasonable fees and expenses incurred in collecting past due balances, including but not limited to LKQ’s reasonable attorneys’ fees, court costs, litigation expenses, and/or collection agency fees and expenses. This credit agreement and all other agreements and contracts between Applicant and LKQ shall be governed by the laws of the State of Illinois. Any and all disputes arising from or related to this credit agreement shall be litigated exclusively in state or federal court located in Chicago, Illinois, to whose jurisdiction Applicant irrevocably consents.

Click here to indicate that you have read and agree to the Terms and Conditions.
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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 KAO via e-mail at CreditTeam@LKQCorp.com 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.

Please attach your state re-sale/exemption certificate(s) :
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Please Note: Multiple files can be submitted, but file(s) must be saved to the same location on your PC. Please press CTRL key for selecting multiple files.

Your application has been successfully submitted.

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
Reason for Account Application (select one):
How did you hear about us? / Reference Code (if applicable) :
Payment Terms Requested:
Payment Terms Requested:
General Business Information
Business Name (Full Legal Name):
D/B/A or Trade Name (if any):

Shipping Address

Billing Address

Shipping Address:
Address:
Shipping Address Line 2:
Address Line 2:
Shipping Address City:
City:
State: AL
State: AL
Zip / Postal Code:
Zip / Postal Code:
Primary Contact:
Primary Contact:
Email Address:
Secondary Address:
Website Address:
Business Type:
Federal Tax ID Number:
Sales Tax Exemption #:
Annual Revenues:
Expected Monthly Purchase:
Number of Employees:
Number of Install Bays:
Number of Install Bays:
Primary Business Focus:
Authorized Buyer Name(s):
Authorized Buyer Phone #:
Authorized Buyer Fax #:
Authorized Buyer Email:
Accounts Payable Contact:
Accounts Payable Phone:
Accounts Payable Fax:
Ownership
Ownership :

Ownership 1

Ownership 2

Name of Principal(s):
Name of Principal(s):
Title:
Title:
Phone:
Phone:
% of Ownership:
% of Ownership:
History
Facilities:
Business Owned Since: /
Number of Years at Present Location:
Have You Ever Filed for Bankruptcy?:
Is your Business a Franchise?:
Bank Reference
Business Account Type:
Bank Name:
Address:
Address Line 2:
City:
State: AL
Zip / Postal Code:
Account Manager to Contact:
Email :
Fax Number:
Phone Number:
Date Account Established: /
Trade References

Reference 1

Reference 2

Reference 3

Business Name:
Business Name:
Business Name:
Contact Name:
Contact Name:
Contact Name:
Phone:
Phone:
Phone:
Fax:
Fax:
Fax:
Email:
Email:
Email:
KeyStone Automotive

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