Customer Credit Application
Items marked with a * are required.
*Customer Type:
*Tax Status:
If non taxable fill out and fax back the Texas Resale Certificate.
*Telephone #:
*Fax #:
*Legal Name:
*Doing Business As:
*Addr 1:
*Addr 2:
*City:
*State:
*Zip Code:
Delivery Address? Yes No
Select One: Corporation Partnership Proprietorship
Date Established :
State of Incorp:
Name:
Address:
Credit Limit Requested:
Credit App Contact
Parent Company if Applicable:
Has any owner filed for bankruptcy in the last 7 years?
Yes
No
Title:
% Ownership:
Telephone:
Fax:
Contact:
Account #:
Phone:
Your name :
Your E-Mail address :
Send me a copy of this report
