Application for Credit

P.O. Box 26
Albion, PA 16401

Ph. (800) 756-8077
Fax (800) 756-9077

Date:

Phone Number:

Fax Number:

Business Name:

Please check one: Individual [ ] Partnership [ ]

Corporation ________________________ (Fed. Tax No.)
State Tax No. _______________________ (Send Copy)

Mailing Address:

City:

State:

Zip:

Shipping Address:

City:

State:

Zip:

Individual or Partnership

Name:

Social Security Numbers:

Address:

1


2


Corporation - Please List All Officers (Full Name and Title)

1

Title
2

 Title
3

 Title
4

 Title

Important Information (please complete all areas)

Name of Business:

 Date Started:
Estimated Annual Sales
$_________________		 Number of Employees
D & B Rated?
[ ] Yes [ ] Not at this time		 Approximated Net Worth
$___________________
Credit Line Desired Per Month
$_________________		 Approximate Amount of 1st Order
$__________________

Tax Exempt: [ ] Yes [ ] No If yes, send us a completed exemption certificate

If your anticipated Credit Limit is more than $4,000 per month, please attach:
1. Latest Year End Financial Statement 2. Latest Interim Financial Statement

We MUST also have page two of the credit application - CLICK HERE

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