1118 Union Boulevard Allentown, PA 18109-1913
Phone: 610.437.5409 Fax: 610.437.2559

 

CREDIT APPLICATION

 

Credit Terms: Net 30 Days
Credit Granted $
 
Effective Date:
To Be Completed By Customer:
    
Company Name:
  
Phone No: ( )
Address:
  
Fax:
   
E-mail:
   
Proprietorship:
Parent Co.
  
Partnership:
Address:
  
Corporation:
   
Type of Business:
   
Years in Existence:
   
Purchase Order Required:
BANK AFFILIATION:    
Name of Bank:
  
Phone No.: ( )
Address:
  
Contact:
   
Account No.:
 
TRADE REFERENCES:
1:
2:
3:
     
Phone:
Phone:
Phone:
Fax:
Fax:
Fax:
     
PRINCIPALS OF COMPANY
Name:
Title:
Phone No.:
     
     
     
     
  Authorized Signature: Date:
  Typed Name & Title: