Credit Application

Company Name

Date

Street

City

Zip Code

Ownership (Check One)
CorporationPartnershipSoleOther

Name of President or Owner(s)

Person to Contact - Purchasing

Person to Contact - Accounts Payable

P.O. Box

State

Telephone Number

Fax Number

Business Description

Type of Business (Check One)
DomesticInternationalWholesaleOEM

Home Office

Subsidiary or Division of

Resale Tax Number

Other Remarks

Trade References within the Refrigeration Industry:
#1. Name

Address

City

State

Zip

Fax #

#2. Name

Address

City

State

Zip

Fax #

#3. Name

Address

City

State

Zip

Fax #

#4. Name

Address

City

State

Zip

Fax #

#5. Name

Address

City

State

Zip

Fax #

#6. Name

Address

City

State

Zip

Fax #

(Please provide complete mailing address and fax number)
THE INFORMATION GIVEN ABOVE WILL BE TREATED STRICTLY CONFIDENTIAL AND WILL BE USED ONLY AS A BASIS FOR OPEN ACCOUNT CONSIDERATION. CURRENT FINANCIAL STATEMENTS MAY BE PROVIDED, IF AVAILABLE.
I hereby authorize the release of any credit information by above references. I understand that credit terms are Net 30 days. Where credit is not approved terms are COD or cash with order. All shipments are FOB our factory, payment must be in U.S. Dollars.
Name (required)

Title (required)

Your Email (required)

Human Verification *