Credit Application

General Information

*Company Name

DBA

D&B#

Type of Business

Corporation

LLC

Partnership

Single Proprietorship

Others

Title

Fax

*Address

*City

*State

*Zip

*Contact Name

*Phone

Bank Reference

Bank Name

Telephone

Fax

Bank Contact Name

Bank Contact Title

Bank address

City

State

Zip

Vendor 1

Vendor 1 Name

Vendor 1 telepone

Vendor 1 account #

Vendor 1 Nature of Business

Vendor 1 Address

Vendor 1 Fax

Vendor 1 Contact Name

Vendor 2

Vendor 2 Name

Vendor 2 telepone

Vendor 2 account #

Vendor 2 Nature of Business

Vendor 2 Address

Vendor 2 Fax

Vendor 2 Contact Name

Vendor 3

Vendor 3 Name

Vendor 3 telepone

Vendor 3 account #

Vendor 3 Nature of Business

Vendor 3 Address

Vendor 3 Fax

Vendor 3 Contact Name

Additional Information

Terms

All information contained in this credit application is true and accurate and is furnished to Industrial Motors in order to induce Industrial Motors to grant credit to customer. Customer authorizes Industrial Motors to obtain credit and financial information concerning Customer at any time and from any source and agrees to hold harmless Industrial Motors against any claim for doing so.

Applicant Name

(800)542-4058

General Information

Bank Reference

Vendor 1

Vendor 2

Vendor 3

Additional Information

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INFORMATION

USER ACCESS

POLICY & INFORMATION