Perma-Patch » Manufacturers Represented

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Perma-Patch

Perma-Patch Featured ProductsPermanent asphalt patching material – all season, all weather – provides durable bond to asphalt, concrete, steel, wood and other hard surfaces – available in easy to handle bags, pails or in bulk – minimum bag shelf life of two years

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Credit Application

Credit Application

If you are a distributor and would like to purchase items from us for resale, we would be happy to consider opening a credit line for your company. Please complete the information below for review and verification. This form is secure for your protection. Please submit this form for each business location.


If your shipping address is different than your billing address above, please provide it here.

If your company phone and fax is different than your billing phone and fax, please provide it here.

Please provide at least four (4) trade references.

Please provide a bank reference.

If you have not yet been contacted by anyone at Lawless Sales Group, you may leave this field blank.

Please provide some additional information about your company, what products you are interested in, and any other details relevant to this application.

Use the following area below to attach a Sales & Use Tax Certificate. **Note: you must hit the "UPLOAD" button after file has been selected.**
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