Credit Application

CREDIT APPLICATION

The undersigned is applying for credit with ______________ (the "Company") and agrees to abide by the terms and conditions of the Company’s standard contract.

1.  Company Name
     and Address

2.  Phone (     )

Fax (     )

3. Federal Tax ID or Social Security No.

4.  Type of Business

No. of Employees

5.  Date Business Established

6.  Types of Products You Will Purchase

7.  Amount of Credit Requested  $

8.  Check which is applicable to you:

o Corporation

o General Partnership

o Limited Partnership

o LLC

o Sole Proprietorship

o Other :  _________________

9.  State where your company was organized :

10.  Have you or any of your affiliates ever had credit with us before or purchased from us before?  Yes ___  No ___

     If yes, under what name?

11. Name or title of persons authorized to act on your behalf :

12. Trade References

Reference #1 Name and Address:

Phone (       )

Reference #2 Name and Address:

Phone (       )