Credit Application

General Information
 

* Indicates required field

E-mail Address

*

Business' Legal Name

*

Billing Address

*

City, State, Zip Code

*

Telephone/Fax

*/

Contact Person

*

Principal's Name

*

Legal Status of Business

Corporation

*

Partnership

Proprietorship

Social Security Number if
Partnership or Proprietorship

Federal Resale I.D. Number

Profile:

Dealer

School/University

Distributor

Municipality

Fire Dept.

Manufacturer

Police Dept.

Government Agency

 

Other

Finance

Your Bank's Name

*

Bank Address

*

Bank Contact Name

*

Bank Telephone

*

Bank Account No.

*

Trade References

List 3 Trade References and Contacts

1) Name

*

Address

*

Telephone #

*

Fax #

Contact

*

Account #

*

 

2) Name

*

Address

*

Telephone #

*

Fax #

Contact

*

Account #

*

 

3) Name

*

Address

*

Telephone #

*

Fax #

Contact

*

Account #

*

How did you hear of our company?

*

Name of person completing application:

*

Title of person completing application:

*