Industrial Hose and Hydraulics

OEM

Jobber

Describe below

Physical Address

Street Suite City State/Zip

Mailing Address (if different)

Street Suite City State/Zip

Accounts Payable Contact

Contact Business Telephone Fax Phone Number Years in Business

Tax Exempt? If Yes -- attach exemption certificate with application (pdf or jpg).

Yes

Information on Company Officers / Principal or Owner

Name Social Security # Home Phone Street City, State, Zip

Second Principal or Owner

Name Social Security # Home Phone Street City, State, Zip

Banking and Credit References

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

Principal Bank Reference

Bank Address City State, Zip Account#

Additional Bank or Credit Reference

Bank Address City State, Zip Account#

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.

Name Address City State, Zip Account# Phone # / Fax #

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

Name Address City State, Zip Account# Phone # / Fax #

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

Name Address City State, Zip Account# Phone # / Fax #

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

Name Address City State, Zip Account# Phone # / Fax #

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?

Yes

Statement Requested?

Yes

Applicant's Name

TitleDate of Application

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

Industrial Hose & Hydraulics

CREDIT APPLICATION

Credit Application - Online Form

General Company Information

Business Classification

Type of Business

Physical Address

Mailing Address (if different)

Accounts Payable Contact

Information on Company Officers / Principal or Owner

Second Principal or Owner

Banking and Credit References

Principal Bank Reference

Additional Bank or Credit Reference

Trade References (4 required)

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.

Submit Application