Application for Credit

* Required fields for application.

*Date
*Salesman
*Company Name
*Company Address
*Mailing Address
*Email Address
*Phone Number
*Fax
*Officers
Name
Address
Phone
*Accounts Payable Contact
*Accounts Payable Phone
Select Appropriate
*Federal ID#
Are you Exempt from Indiana or Michigan sales tax?

If yes, you will be required to present documentation at a later date.

*Company Bank
*Contact Person
*Bank Phone Number
*Fax Number
*Please list four trade references specific to the building materials industry.
Name
Address
Phone
Fax
1+1=?