Credit Application

TEL: 630-629-3320

FAX: 630-629-3324

700 Frontier Way
Bensenville, IL 60106

CREDIT APPLICATION


BILL TO ADDRESS		SHIP TO ADDRESS
COMPANY NAME _______________________ ADDRESS ______________________________ ________________________________________ PHONE # _______________________________ FAX# __________________________________		COMPANY NAME _____________________ ADDRESS ____________________________ ______________________________________ PHONE # _____________________________ FAX# _________________________________
Bank Reference
BANK NAME ____________________________ ADDRESS________________________________ __________________________________________		ACCOUNT # ____________________________ PHONE # _______________________________ CONTACT ______________________________
Please Provide Three References
NAME ________________________________ ADDRESS_____________________________ CONTACT_____________________________		PHONE # ____________________________ FAX # _______________________________ CONTACT ___________________________

NAME ________________________________ ADDRESS _____________________________ CONTACT _____________________________		PHONE # _____________________________ FAX # ________________________________ CONTACT ____________________________

NAME ________________________________ ADDRESS _____________________________ CONTACT ____________________________		PHONE # _____________________________ FAX # _______________________________ CONTACT ___________________________

Years in business _______

Type of business ___________________ (corporation, partnership or sole proprietorship)

Our terms are 1% 15 Days, Net 30. WILL YOU PAY WITHIN TERMS?_________

Will you play later than 30 days? ________________ If so, how many days? __________

Please MAIL or FAX completed form. If you have any questions please call us.

THANK YOU VERY MUCH. We will advise once this application is accepted.

SIGNATURE __________________________ PRINT NAME ________________________

For Illinois and Iowa Customers only:

Will product purchased be taxable or tax exempt? ______________
If tax exempt, provide your state resale or ID number ____________________ Print this page Home