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Credit Application

NOTE: MasterCard, Visa & American Express Accepted

 General Information
Company Name
Address
City
State
Zip
Phone
Type of Business
   
 Accounts Payable Contact Information
Name

Phone/Extension
Person Reports To

Phone/Extension
Billing Address
(if different than above)
City
State
Zip
   
 Company/Banking Information
Federal ID Number
State Incorporated
Year
Bank
Account Number
Address
City
State
Zip
Phone
Contact Name
   
 Please List Three Trade Credit References
Company Name
Address
City
State
Zip
Phone
Account #
   
Company Name
Address
City
State
Zip
Phone
Account #
   
Company Name
Address
City
State
Zip
Phone
Account #
   
Payment is due within 30 days from the date of invoice. An interest rate 1.5% per month will be added to past due accounts.  Any collection costs, including attorney fees, will be added to invoice.  Delinquent freight bills are subject to loss of any and all discounts.  Any account exceeding the credit terms extended will automatically fall into a CASH only status and will require payment in full to re-establish original terms.