APPLICATION FOR CREDIT
You can also download a printable credit application.
CreditApp.pdf (58.9KB)
Company Information
* Location
Select One
Fort Smith, AR
Little Rock, AR
Joplin, MO
Oklahoma City, OK
* Name
Bill To
* Address 1
* Address 2
* City
* State
* Zip
Ship To
* Address 1
* Address 2
* City
* State
* Zip
* Type of Business
FEIN
* Year Est.
Sales Tax Permit #
SIC Code
Receiving Information
Receiving Days
Receiving Hours
Unloading Requirements
Packaging Requirements
Owner(s) or Officers
* Name
* Title
* Name
* Title
Is Your Company a Subsidiary or Division of Another Entity?
Yes
No
If yes, please indicate the Name.
Entity Name
Purchasing Agent Information
* Name
Email
* Phone
Fax
Accounts Payable Agent Information
* Name
Email
* Phone
Fax
* Credit Limit Requested
Bank Information
* Name
* Address
* Phone
* Bank Contact
Suppliers/Trade References
* Name
* Address
* Phone
Fax
* Name
* Address
* Phone
Fax
* Name
* Address
* Phone
Fax