Credit Application And Trade References Form - 2014

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CREDIT APPLICATION
In order for you to open an account with our company, we ask that you fill out the following information completely.
Company Name
______________________________________________________________________________________________________
Street Address (required) ________________________________________________________________________________________________
City
_______________________________________________________
State ___________________
Zip _____________________
Billing Address
_______________________________________________________________________________________________________
City
_________________________________________________________
State ___________________
Zip _____________________
Phone ( _________ ) ______________________
Fax ( ________) _______________________
Years in Business
____________
Parent Company or Affiliation Number of Employees __________________________________________________________________________
Address _____________________________________________________________________________________________________________
City
_________________________________________________________
State ___________________
Zip _____________________
President ______________________________________________
Controller
_________________________________________________
Form of Organization
Corporation
Partnership
Sole Proprietor
LLC/LLP
Nature of Business ____________________________________________________________________
SIC Code ____________________
Approximately what do you anticipate will be your monthly purchases? ____________________________________________________________
Will your purchases be subject to Wisconsin sales tax? ________________________________________________________________________
If not, please enclose the appropriate exemption certificate, if applicable.
TRADE REFERENCES
Name
______________________________________________________________________________________________________________
Address _____________________________________________________________________________________________________________
City
_________________________________________________________
State ___________________
Zip _____________________
Phone ( _________ )
____________________________________
Fax ( _______________)
__________________________________
Name
______________________________________________________________________________________________________________
Address _____________________________________________________________________________________________________________
City
_________________________________________________________
State ___________________
Zip _____________________
Phone ( _________ )
____________________________________
Fax ( _______________)
__________________________________
Name
______________________________________________________________________________________________________________
Address _____________________________________________________________________________________________________________
City
_________________________________________________________
State ___________________
Zip _____________________
Phone ( _________ )
____________________________________
Fax ( _______________)
__________________________________
The back of this application must be completed prior to processing.

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