Credit Application

Name of firm or individual:

Years in business:

Address:

City:	State/Province:	Zip:
Sales Tax ID #:	Phone:	Fax:

E-Mail:

Website:

HEREBY applies for credit in accordance with the terms and conditions of:
NET 30 DAYS

The following information must be provided. It will be held in the strictest confidence.

Ownership:

Check here if incorporated within the past 12 months

Corporation Partnership Individual

Name of principal 1:

Phone:

Fax:

Complete address:

Name of principal 2:

Phone:

Fax:

Complete address:

Finance:

Bank:

Bank officer or department:

Bank address:

Phone:

References:

Business Name 1:

Phone:

Fax:

Complete address:	Account #:

Business Name 2:

Phone:

Fax:

Complete address:	Account #:

Business Name 3:

Phone:

Fax:

Complete address:	Account #:

Business Name 4:

Phone:

Fax:

Complete address:

Account #:

Until our credit is approved we would prefer to pay by:
C.O.D. Visa Mastercard American Express

How did you hear of Freeman Manufacturing Company?

We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.

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