Name*:
Email*:
Date:
Maximum credit line applied for:
Company:
Phone:
Mailing Address:
Shipping Address:
Type of Business:
Year Established:
Est. Annual Sales:
Tax ID:
YesNo
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Officers/Owners:
Accounts Payable/Controller:
If you are tax exempt and in the state of Pennsylvania, please include a tax exempt form with this application.
Only list the following trade references:
Bank reference must have a credit relationship (i.e., LOC, Term Loan, Mortgage, Auto Loan, etc...)
A separate listing is acceptable, however a signed application must be returned with the list.
Supplier/Vendor:
Address:
Fax:
Contact:
Account Number:
The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize the firm to whom this application is made to investigate the references pertaining to my/our credit and financial responsibility. Applicant's signature attests financial responsibility, ability and willingness to pay invoices in accordance with the terms of sale. All past due invoices are subject to a 1-1/2% monthly interest charge. In accordance with terms granted, applicant agrees to pay all reasonable costs of collection, including reasonable attorney fees, in case of suit for non-payment of any past due amounts.
Authorized Signature*:
title:
FINANCIAL STATEMENTS TO BE PROVIDED AS PART OF THE INFORMATION OF CREDIT APPLICATION.
MAIL COMPLETED FORM AND FINANCIAL STATEMENTS TO: Fayette Custom Wire Products, Attn: Credit Dept., 18 Mount Pleasant Road, Scottdale, PA 15683
UPON CREDIT APPROVAL, PLEASE MAIL ALL PAYMENTS TO: Fayette Custom Wire Products, PO Box 3475, Pittsburgh, PA 15230-3475
Please call (724) 887-8100 with questions or concerns. Fax: (724) 887-7723
