Credit Application


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COMPANY INFORMATION

COMPANY:

ADDRESS:

ADDRESS:

CITY:

STATE:

ZIP:

E-MAIL:

TELEPHONE:

FAX:

STRUCTURE:

INDUSTRY:

NO. OF YRS IN OPERATION:

FEDERAL ID#:

P.O. REQUIRED?:

yes no

MD. TAX EXEMPT:

yes no
If yes, a copy of your exempt certificate must be sent to Alliance Material Handling, Inc.

 

PARENT COMPANY INFORMATION

PARENT COMPANY:

ADDRESS:

ADDRESS:

CITY:

STATE:

ZIP:

TELEPHONE:

FAX:

MAIL TO:

PARENT CO.

THIS LOCATION

 

CREDIT INFORMATION

NAME OF BANK:

BRANCH:

TELEPHONE:

ACCOUNT NUMBER:

REFERENCE #1:

ADDRESS:

TELEPHONE:

ACCOUNT NUMBER:

REFERENCE #2:

ADDRESS:

TELEPHONE:

ACCOUNT NUMBER:

REFERENCE #3:

ADDRESS:

TELEPHONE:

ACCOUNT NUMBER:

Alliance Material Handling, Inc.payment terms are net 10 days. Accounts 60 days past due are subject to a monthly service fee of 1%. Applicant is responsible for all collection, attorney and court fees that may be incurred, as the result of account being placed for collections. Check below if the authorized agent agrees to the above terms.

I authorize the above creditors to release all information needed to this vendor for credit approval.
AUTHORIZED AGENT TITLE DATE