Credit Application

COMPANY INFORMATION

Company Name

Billing Address

Service Address (if different from Billing Address)

Phone Number

Fax Number

Federal ID #

Duns #

Taxable?
YesNo (attach Sales Tax Exemption Form below

Company Classification
Corporation (S)Corporation (C)Corporation (LLC)Sole ProprietorshipPartnership

PRINCIPAL OFFICERS

Officer 1 Name & Title

Officer 2 Name & Title

Officer 3 Name & Title

ACCOUNTS PAYABLE
Accounts Payable Contact

Accounts Payable Phone Number

Accounts Payable Email

BANK REFERENCES

Name of Bank

Bank Contact

Bank Phone Number

Bank Fax Number

TRADE REFERENCES
Reference 1: Name - Contact - Phone - Fax

Reference 2: Name - Contact - Phone - Fax

Reference 3: Name - Contact - Phone - Fax

Please upload your Sales Tax Exemption Form (if applicable)

Please upload your Credit References (if applicable)

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