All Industrial Engine Service
Credit Application

Please provide the following "Bill To" information:

Contact Name:
Title:
Company Name:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:
Web Address:

Please provide the following "Ship To" information:

If same as "Bill To" check here:   

DO NOT FILL IN THE SHIP TO: INFORMATION IF YOU
CHECKED THE BOX ABOVE.

Company Name:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:

 

Please provide the following Company information:

            Choose one of the following classifications:  Company Type Corporation Partnership Individual

List Owners, Partners, or Officers:
List your Purchasing Agent(s):
Accounts Payable Manager
In Business Since:
Number of Employees:

   

        Bank Reference:

Bank Name:
Bank Account #:
Bank Phone Number:

First Business Reference:

Company Name:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal code:
Country:
Phone:
Fax:
E-mail:

Second Business Reference:

Company Name:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:

Third Business Reference:

Company Name:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:

(For Approval)  I give All Industrial Engine Service permission to check the credit history of the information you have listed above, including business and bank references.