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Credit Application

Legal Name of Business:	Phone:
Email:	Fax:	Billing Address:
City:	State:	Zip:
International Countries:	Resale or Taxable:	Resale Number:
Delivery Address:	City:	State:
Zip:	Delivery-International Country:	Delivery Phone#:
Business Type:	State Incorporated:
Owners or Partner's Name:	Date Business Started:

If Corporation:
President:		Vice President:
Secretary:		Treasurer:
Nature of Business:		How Long at Present Location:
Do you own or lease the facilities your business occupies?		Are you willing to provide a recent financial statement if requested?