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Credit Application

Company Information

Company Name:
Owner's Name


Billing Address:
City:
State:
Zipcode:
Phone:
Fax:


Accounts Payable Information

A/P Representative:
A/P Phone Number:
A/P Email Address:
OK To Email Invoices?YesNo
Federal Tax ID:
CA Resale Certificate:
(California Businesses Only)
Company Website Address:
(If Applicable)
Years at Present Address:
Ever Filed for Bankruptcy?YesNo


Credit References

Company #1:Account #:Phone #:
Fax #:Annual Purchases:

Company #2:Account #:Phone #:
Fax #:Annual Purchases:

Company #3:Account #:Phone #:
Fax #:Annual Purchases: