"Credit Application Form - West Penn Wire" - Pennsylvania

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Download "Credit Application Form - West Penn Wire" - Pennsylvania

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West Penn Wire Credit Application
Fax and phone
In order to expedite your credit approval, please provide the following information.
numbers are required for each reference
. Please ensure that all information is current and
Your Company Name:
Your Company’s Billing Address:
Your Company’s Physical Address:
Your shipping address if it is always the same: (If it varies, please write “Various”:
Your Phone #:
Your Fax #:
Your DUNS #:
Company President’s Name:
Accounts Payable Contact Name
Phone#
Email:
Company is a:
Company Resale #:
Partnership
Sole Proprietor
Corporation
State:
Year estabished:
Bank Reference:
Bank Name:
Bank Name:
Bank Contact;
Bank Contact;
Bank Account #:
Bank Account #:
Type:
Type:
Bank Phone #:
Bank Phone #:
Bank Fax #:
Bank Fax #:
Trade References:
Name:
Name:
Contact:
Contact:
Account #:
Account #:
Address:
Address:
Phone#:
Phone#:
Fax #:
Fax #:
Email:
Email:
Name:
Name:
Contact:
Contact:
Account #:
Account #:
Address:
Address:
Phone#:
Phone#:
Fax #:
Fax #:
West Penn Wire Credit Application
Fax and phone
In order to expedite your credit approval, please provide the following information.
numbers are required for each reference
. Please ensure that all information is current and
Your Company Name:
Your Company’s Billing Address:
Your Company’s Physical Address:
Your shipping address if it is always the same: (If it varies, please write “Various”:
Your Phone #:
Your Fax #:
Your DUNS #:
Company President’s Name:
Accounts Payable Contact Name
Phone#
Email:
Company is a:
Company Resale #:
Partnership
Sole Proprietor
Corporation
State:
Year estabished:
Bank Reference:
Bank Name:
Bank Name:
Bank Contact;
Bank Contact;
Bank Account #:
Bank Account #:
Type:
Type:
Bank Phone #:
Bank Phone #:
Bank Fax #:
Bank Fax #:
Trade References:
Name:
Name:
Contact:
Contact:
Account #:
Account #:
Address:
Address:
Phone#:
Phone#:
Fax #:
Fax #:
Email:
Email:
Name:
Name:
Contact:
Contact:
Account #:
Account #:
Address:
Address:
Phone#:
Phone#:
Fax #:
Fax #:
Email:
Email:
Please provide tax exempt cert.
Tax Exempt
Yes/No
Date:
Signature:
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