Request for Credit Approval

Company Information
Date:
Company Name:
Address:
Address 2:
City:
State:
Zip:
Billing Address:
Billing Address 2:
City:
State:
Zip:
Phone:
Fax:
Company Ownership	Sole Proprietorship Partnership Corporation
Tax Identification Number
Years In Business
Name of Owners
Accounts Payable Manager
Bank Information
Bank Name
Account Number
Contact Name
Telephone Number
Trade References
Company Name
Account Number
Address
Phone Number
Fax Number

Company Name
Account Number
Address
Phone Number
Fax Number

Company Name
Account Number
Address
Phone Number
Fax Number
	You must have fax and account numbers on all trade references.
You may either submit this form electronically by pressing the "submit button below, or fax the completed form to: Attn: Accounting Fax: (770) 763-5935 or (800) 591-6860