|   MY ACCOUNT   |   Cart CART  
Home
About Us
Online Catalog
Core Return Status
Warranty Check
Sell Us Your Cores
Technical Help
Contact Us

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Application

Name/Address

Last:   First:    Middle Initial: Title:
Name of Business:   Tax ID Number:  
Address:  
City:   State:   Zip:   Phone:  

Company Information

Type of Business:   In Business Since:  
Legal Form of Business:    Corporation    Partnership     Proprietorship
Name of Parent Company (if applicable):
1st Company Principal:   Title:  
Address:  
City:   State:   Zip:   Phone:  
2nd Company Principal:   Title:  
Address:  
City:   State:   Zip:   Phone:  

Trade References

Company Name:
  		Company Name:
  		Company Name:
Contact Name:
  		Contact Name:
  		Contact Name:
Address:
  		Address:
  		Address:
Phone:
  		Phone:
  		Phone:
Fax:
  		Fax:
 		 Fax:
Account #:
  		Account #:
 		 Account #:

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied in order to verify the information contained herein.

Submitted By:   Date: