Form 31-014 - Iowa Sales Tax Exemption Certificate - Credit Application - 2006
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1
2
3Remit to:
PO Box 1365
Bloomington, IL
61702-1365
(Tel) 309-820-0566
(Fax) 309-820-0545
Credit Application
Date:
Business Name
Phone
Fax
Business Street Address/PO Box or RR
City/County/State/Zip
Home Office Street Address/PO Box or RR
City/County/State/Zip
Customer E-mail Address
Bank Reference Name
Bank Officer
Phone
Address/City/State/Zip
Tax Exempt
Yes
No
Sales Tax Exemption Number
*(If yes: attached is your State’s sales tax exemption certificate. This form must be completed in full, signed, and
returned with a copy of your company’s registration license.)
Type of Ownership
Proprietorship
Partnership
Corporation
Number of years in business
FEIN Number
Holt Supply Company location you will frequent most:
Bloomington
Burlington
Champaign
Galesburg
Princeton
Sioux Falls
Type of Business:
Contractor: Plumbing
Retail Store: Hardware, Appliances
Contractor: Plumbing, Heating, Cooling, HVAC Service
Apartment House Maintenance
*(Copy of Refrigerant Certificate required)
Industrial Account, Manufacturing
Government Agency
Other (please specify)
Building Contractor
Purchase Order Required
Yes
No
Shipping Tickets Prices
Yes
No
Send Invoices to
Home Office
Field or Branch Store
Fax Invoice in lieu of U.S Mail
Monthly Statement Required
Yes
No
Mail to
Home Office
Field or Branch Store
Contact Regarding Material, Returns
Phone
Contact Regarding Payables
Phone
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Related Categories
Parent category: Business