Credit Application

    Name*:

    Email*:

    Date:

    Maximum credit line applied for:

    Company:

    Phone:

    Mailing Address:

    Shipping Address:

    Type of Business:

    Year Established:

    Est. Annual Sales:

    Tax ID:

    Business Incorporated?
    YesNo

    State of Incorporation:

    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:

    • Major supplier/vendor - minimum $2,000 recent high credit
    • Must have done business with supplier/vendor for at least 1 year and within the last 30 days

    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:

    Phone:

    Fax:

    Contact:

    Account Number:


    Supplier/Vendor:

    Address:

    Phone:

    Fax:

    Contact:

    Account Number:


    Supplier/Vendor:

    Address:

    Phone:

    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:

    Date:

    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

    Fayette Custom Wire Products

    18 Mount Pleasant Road Scottdale, PA 15683

    Phone: 724.887.8100
    Toll-free: 800.426.1983
    Fax: 724.887.7723

    Email: info@fayettewire.com

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