CREDIT APPLICATION



You will be notified within 5 business days of your credit status.

Please note: This application consists of seven sections:

  1. Company Information
  2. Owner/Officer Information
  3. Bank Information
  4. Trade Credit Information (3)
  5. Billing Information
  6. Ship To Information
  7. Credit Agreement

Be sure you have access to the above information before you begin. You might allow 20-30 minutes to complete the application.

COMPANY INFORMATION

 Customer Name

 

Phone

 

E-Mail Address

Street Address 1

 

Street Address 2

 

Mailing Address

 

City

 

State

 

Zip

 

Check one:

Corporation Partnership Proprietorship

State of Incorporation

Are you sales tax exempt?

Yes No

Type of Business

OWNER/OFFICER INFORMATION

Name

Title

Home Address

Phone

City

State

Zip

BANK INFORMATION

Bank Name

Account Number

Contact

Address

Phone

City

State

Zip

TRADE CREDIT REFERENCES - #1

Name 

 

Acct. Number

 

Contact

Address

 

Phone No.

 

City

 

State

 

Zip

 

 TRADE CREDIT REFERENCES - #2

Name

Acct. Number

Contact

Address

Phone No.

City

State

Zip

TRADE CREDIT REFERENCES - #3

Name

Acct. Number

Contact

Address

Phone No.

City

State

Zip

BILLING INFORMATION

Customer Name 

 

Physical Address

 

Mailing Address

 

City

 

State

 

Zip

 

Attention

 

Telephone

Fax

Purchasing Contact

Purchasing Telephone

Fax

Purchase Order Number required

Yes No

No. of invoice copies required

Amount of credit requested

.. $

Accounts Payable Contact

A/P Telephone

A/P Fax

Tax Location

Taxable Status

Taxable Non-Taxable*
   

Comments:

SHIP TO INFORMATION

 Customer Name

 

Attention

 

Address 1

Address 2

City

 

State

 

Zip Code

 

Special Shipping Instructions:

 
 

By submitting this form I certify that all the information provided is true and complete.


CREDIT AGREEMENT

Note: A copy of our credit agreement must be faxed to American Steam, Inc.
Click here to complete this form.


*If you are non-taxable, please fax a copy of the "Texas Sales Tax Resale Certificate" to 972-442-4991. (Back to application.)