Credit Application

Date
Salesman
Company Name
Company Address
Mailing 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