Call for FREE Quote 1-800-442-0311
Pompano Beach - (954) 960-0311
Ft Lauderdale/Port - (954) 525-8165

CREDIT APPLICATION

2450 North Powerline Road, Suite # 1
Pompano Beach, FL 33069-1051
Ph: 954.960.0311 • Fax: 954.960.0533

Thank you for requesting a credit application and your interest in opening a charge account. We appreciate your interest and will begin processing your application upon completion. Upon approval you will be notified as to when you may begin using the account.
Payment is due Net 30 days from invoice date. The following must be filled out completely in order to process the application.

Credit Application - Online Form

Please provide complete information in ALL sections.

General Company Information
Business Classification

Type of Business

Physical Address
Mailing Address (if different)
Accounts Payable Contact
Tax Exempt? If Yes -- attach exemption certificate with application (pdf or jpg).
Information on Company Officers / Principal or Owner
Second Principal or Owner
Banking and Credit References

Please fill out forms below or attach Banking and Credit References (pdf or jpg)

Principal Bank Reference
Additional Bank or Credit Reference
Trade References (4 required)

Please fill out forms below or attach Trade References (pdf or jpg)

Trade Reference #1 (minimum 4 required) Please provide fax & account numbers.
Trade Reference #2 (minimum 4 required) Please provide fax & account numbers.
Trade Reference #3 (minimum 4 required) Please provide fax & account numbers.
Trade Reference #4 (minimum 4 required) Please provide fax & account numbers.

TERMS AND CONDITIONS Applicant Hereby Acknowledges the following: The information supplied by applicant is complete and accurate. Industrial Hose & Hydraulics’ terms for extension of credit are 30 days NET. Industrial Hose & Hydraulics Inc. reserves the unconditional right to refuse credit or, to close any account, at any time, without prior notice. Closed credit accounts become payable, in full, immediately.

Purchase Orders Required?
Statement Requested?

By clicking Submit Application you agree all statements are true and agree to the Terms and Conditions set forth above.