Credit Application:

Before proceeding, please take a minute to review Adaptall's sales policy.

Billing Address  
Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
 U.S.A
Type of address:
General Info  

General Telephone:
( ) - -
General Fax:
( ) - -
Contact E-mail:
Web site address:
   
Owner or officers:
Payable contact:
# Years in business:
Federal ID# (EIN#):
- i.e. ##-#######

Bank Details  
Bank Name:
Bank Address:
City:
State/Province:
Zip/Postal Code:
Bank Telephone:
( ) - -
Bank Fax:
( ) - -
Bank Contact:
BUSINESS REFERENCES  
1)
For reference #1, please list the Hydraulic Hose & Coupling manufacturer that you represent
Company Name:
(why?...)
Address:
City:
State/Province:
Zip/Postal Code:
Telephone:
( ) - -
Fax:
( ) - -
Contact name:
   
2)  
Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Telephone:
( ) - -
Fax:
( ) - -
Contact Name:
 
3)
Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Telephone:
( ) - -
Fax:
( ) - -
Contact Name:
Document Transfer Preferences
*Accounting* related documents(i.e. Invoices, monthly statements, trial balances)
Please send accounting related documents to me via:


Email Address to send to:
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verification text shown
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