CREDIT APPLICATION (******Print out and return by fax or mail for processing******)
Company Information Company
Name___________________________________________________________________
Address_________________________________________________________________
City, State, Zip_____________________________________________________________
Years at this address________________________________________________________
Year business established_____________________________________________________
Federal ID # or S.S. Number__________________________________________________

Corporate Officer's
President________________________________________________________________
V.P.___________________________________________________________________
Secretary and Treasurer_____________________________________________________
Contact person for Accounts Payable___________________________________________
Phone Number____________________________________________________________
Fax Number______________________________________________________________

Bank References Bank
Name__________________________________________________________________
Address_________________________________________________________________
City, State, Zip____________________________________________________________
Contact person and phone/fax numbers__________________________________________

Credit References
Company Name___________________________________________________________
Address______________________City, State, Zip________________________________
Contact and phone/fax numbers________________________________________________
Company Name___________________________________________________________
Address______________________City, State, Zip________________________________
Contact and phone/fax numbers________________________________________________
Company Name___________________________________________________________
Address______________________City, State, Zip________________________________
Contact and phone/fax numbers________________________________________________

I Certify that the information given on this application is true and correct to the best of my knowledge. I also agree to abide by your credit terms, and further agree that a service charge of 1-1/2%, 18APR will be added to all past due invoices.

Name (Please Print)__________________________________Title_________________________
Signature___________________________________________Date________________________
Phone Number__________________
Fax Number____________________

Please send a copy of your tax exemption certificate if applicable…