Credit 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

Enter code below to submit form: