Customer Account Application

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Customer Account
Application
Contact Information
Company Name
Date
Contact Name
Title
Address
Phone
City, State, Zip
Email
Billing Information
Contact Name
Phone
Billing Address
Email
*If different from address above
Billing Preference (select one)
Mail
Email
Is PO Number Required? (select one)
Yes
No
Customer Agreement
All invoices are to be paid 30 days from the date of the invoice.
Claims arising from invoices must be made within seven working days.
Additional credit information/trade references may be requested during the approval
process.
If Sales Tax Exempt, please provide a Form ST-105 with this application.
Signature & Date
Printed Name & Title
Wabash Steel Supply Use Only
Approval: Controller, VP, or President - Signature & Date
Credit Limit:
P a g e
| 1
Rev. 04/16

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