Credit Application

Company Name ____________________________
Type of Business ___________________________
Year Established ___________________________
Federal ID Number __________________________

Ship to Address:
____________________________
____________________________
Bill to Address:
____________________________
____________________________

Note: Email is our preferred method of invoicing. It reduces your costs. Please provide an email address where invoices are to be sent: ____________________________________________________

Bank Reference
Bank Name _________________________________________
Bank Address _________________________________________
City, State, Zip _________________________________________
Account Number _________________________________________
Bank Contact _________________________________________
Bank Phone Number _________________________________________
Note: Please provide your tax ID number and a copy of your tax exempt form.

Permission is given by the undersigned to contact any parties for references and relevant information required to establish credit.

Signed _____________________________ Title______________________ Date_________

Trade References

Company ___________________________ Account Number ___________
Contact ___________________________ Phone____________________
Address ___________________________ Fax______________________
City, State, Zip ___________________________ Email_____________________
Years as a supplier to you _______

Company ___________________________ Account Number ___________
Contact ___________________________ Phone____________________
Address ___________________________ Fax______________________
City, State, Zip ___________________________ Email_____________________
Years as a supplier to you _______

Company ___________________________ Account Number ___________
Contact ___________________________ Phone____________________
Address ___________________________ Fax______________________
City, State, Zip ___________________________ Email_____________________
Years as a supplier to you _______