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Credit Application

Credit Application

Thank you for your interest in Martindale Electric Company. In order to establish a credit account with our company, we ask that you complete the following application.

(All fields marked with * are required.)

Business

Business Name*

Address*

City*

State*

Zip Code / Postal Code*

Phone No.*

Fax No.

D.B.A

Same as above

D.B.A - Other

Years of Operation*

Number of Employees*

Business Organization*

Corporation

Subchapter

Partnership

Sole Proprietorship

EIN / SSN*

Other Company

If you are a subsidiary or division of another company, please state the name and address of the company.

Business Principals

Name, Address Principal 1*

Name and business address of company Principal #1 *

Title*

Name, Address Principal 2

Name and business address of company Principal #2

Title

Accounts Payable

Name, Address of person*

Name and address of person who is responsible for handling accounts payable *

Phone No.*

Fax No.

Bank

Bank name and address*

Phone No.*

Trade References

Please furnish 3 US. Trade References

#1*

Length of relationship with this business*

Phone No.*

Fax No.

#2*

Length of relationship with this business*

Phone No.*

Fax No.

#3*

Length of relationship with this business*

Phone No.*

Fax No.

We authorize Martindale Electric Co to conduct a credit check with any or all of the above referenced companies and/or bank, for the purpose of establishing an open account with their company.

Signature*

Signature *

Clear

Name & Title*

Name and Title * (Officer of Company)

Are you human?*

This field should be left blank

Resources

Credit Application

Business

Business Principals

Accounts Payable

Bank

Trade References

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