Credit Application

If your company already has an approved application on file, and you would like it attached to your user account, please fill out this alternate form.

Company

Company Name:

Physical Address

Physical Address:

City:

State:

Billing Address

Address:

City:

State:

Business Information

Phone:

Fax:

Date Established:

Fed ID#:

Officer/Owner:

Officer/Owner Title:

Business Activity:

Accts Payable Contact:

Accts Payable Phone:

Accts Payable Email:

Phone or email address of person to be contacted regarding credit approval:

Amount of Credit Requested:

Bank:

City:

State:

Phone:

Account #:

Credit References

Provide four freight or trade references that have extended credit to your company in the last six months.

Company 1:

Phone 1:

Fax 1:

Company 2:

Phone 2:

Fax 2:

Company 3:

Phone 3:

Fax 3:

Company 4:

Phone 4:

Fax 4:

Sales Representative

Name:

Credit Application

Credit Application

Call Toll-Free (800) 756-1331