Credit Application

It usually takes about 2-3 days to process the application, depending on responses from references. We reserve the right to deny credit based on any information gathered.

Company Information

Company Name
Phone Number
Fax Number
Street Address
City
State
Zip Code
Billing Address
City
State
Zip Code
Purchasing Contact
Email Address
Phone Number
Fax Number
Accounts Payable Contact
Email Address
Phone Number
Fax Number

Tax Status

Tax Exempt- TA ID number
Exemption Type
Year Business Established
Business Type
Owner
President

Bank Information

Bank Name
Address
City
State
Zip Code
Phone Number
Fax Number
Account Number
Contact Person

Trade References

Reference One

Name
Phone Number
Fax Number
Street Address
City
State
Zip Code

Reference Two

Name
Phone Number
Fax Number
Street Address
City
State
Zip Code

Reference Three

Name
Phone Number
Fax Number
Street Address
City
State
Zip Code