Credit Application

Federal ID #
example: 00-0000000

AK Business License #


Social Security #
example: 000-00-0000

Business Name


Mailing Address


Street Address


Telephone #


Fax #


Accounts Payable Contact


Year Established



Type of Ownership (answer A, B, or C)

(A) Corporation  President:   Vice Pres:  Sec/Treas:

(B) Partnership   Name:  Address:  
                  Name:  Address:
                  Name:  Address:

(C) Sole Ownership   Name:  Address:


Local references where credit is currently established.
 (No banks or Credit Unions)

Company Name & Address

	Account #  Telephone #  Fax #
Company Name & Address

	Account #  Telephone #  Fax #
Company Name & Address

	Account #  Telephone #  Fax #




Authorized Buyer Names	Name:   
			Name:   
			Name:   
			Name:   

Do you require Purchase Orders?  Yes  No

Credit Terms

 All accounts are due and payable in accordance with those shown on our invoice. Past due accounts will be closed and subject to collection proceedings and or repossession of the merchandise purchased. Monthly interest charge is .875% on past due invoices.

By clicking submit you are hereby certifying that all information is true and correct and agree to the terms provided.

Your Name: Title: Date:
Email Address: