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CREDIT APPLICATION AFTER COMPLETING THIS FORM, PLEASE PRINT, SIGN AND FAX TO: 1-800-955-4544
Date: _____________ Your Company (bill to location): Company Name: ___________________________________________________________________ Address: _________________________________________________________________________ City: ____________________________________________ State: __________ Zip _____________ Phone: ___________________________ Fax: ___________________________ Accounts Payable Contact Person: ____________________________________________________ Bank Name: __________________________ Bank Phone#________________________________ Bank Address: _____________________________________________________________________ Bank Account Representative: ________________________________________________________ Tax Exempt I.D. # (if applicable): ______________________________________ How many years in business: ___________________ How many years @ current location: _____________ Credit References:
I am certain that all of the above information is current and accurate to the best of my knowledge. I agree to pay our bills in 30 days or less. Signature ______________________________________________ Date _________________________ Title __________________________________________________________________________________ |