Credit Application

Please print and fax the following form to 866-789-4569
or feel free to send us your own form.

Company's name___________________________________________
Address:__________________________________________________
Telephone #_______________________
Fax #_____________________________
Tax I.D.#_________________________
Retail sale certificate#:______________ (copy must be attached)
Kind of ownership:_________________(a) Sole proprietorship (b) Partnership (c) Cooperation (d) other:___________
Owner(s): 1.__________________________________
2.__________________________________
3.__________________________________
Nature of business _______________________________________________________
Year(s) in business:__________________________________________
Financial Corporation:_______________________________________
Address:___________________________________________________
Telephone:______________________
Account#_______________________

Vendors:
(1) Company's name___________________________________________
Address:_________________________________________________
Telephone#_______________________
Fax#____________________________

(2) Company's name___________________________________________
Address:_________________________________________________
Telephone#_______________________
Fax#____________________________

(3) Company's name___________________________________________
Address:_________________________________________________
Telephone#_______________________
Fax#____________________________

(4) Company's name___________________________________________
Address:_________________________________________________
Telephone#_______________________
Fax#____________________________
Signature_________________________ Date__________________
Title:____________________________
I hereby give permission for you to do a credit check on my company
Signature:________________________Date:________________

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