Fill this form out with confidence. None of this information will be transferred over the internet! Simply fill out the form below and click "view form" at the end. A completed Credit Application will pop up in a separate window. Print this out by clicking your right mouse button when the credit application is displayed in its new window and sign where appropriate. Thanks.

This report must be completed in full and submitted before you order or when a new account is opened.

Address Information
Date prepared:
Prepared by:
Factory:
Name of business:
Trade Name - DBA:
Number of years in Business:
Address:
Address:
City:
State:
Zip Code:
Phone:
Country:
Number of locations:

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Ship to Address:
Name:
Address:
Address:
City:
State:
Zip Code:
Special Shipping instructions:
Appointment Required?	Yes No
Days Closed:	Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Shipping & Receiving Contact:
Shipping & Receiving Phone:
Shipping & Receiving hours:

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Credit Information
Expected Volume:	Monthly: $ Annually: $
Business is:	Proprietorship Partnership - List all partners Corporation
Financial officer to Contact Regarding Payments:
Phone:
Name of Bank:
City:
State:
Branch location:
Account number
Account Executive:
Phone:

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Major Credit references
Name:
Phone:
Address:
Address:
City:
State:
Zip Code:
Vendor Account number
Annual Volume:
Name:
Phone:
Address:
Address:
City:
State:
Zip Code:
Vendor Account number
Annual Volume:
Name:
Phone:
Address:
Address:
City:
State:
Zip Code:
Vendor Account number
Annual Volume:
Name:
Phone:
Address:
Address:
City:
State:
Zip Code:
Vendor Account number
Annual Volume:

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