Credit Application

Please complete the following form, then print and fax to our Credit Department at 630-758-1074

 

General Information:
Firm Name:
Parent Company
(if Subsidiary):
Contact:
Address:
City:   Zip:
Phone: Email: 
Type of Business:
At Present Location Since(mm/dd/yy): Year Established:    
Is Business Incorporated?Yes No Under What State?    
References: (Give only names of those you buy from on open account)
Reference #1:
Name:
Address:
City: Zip:
Phone: Email: 
Reference #2:
Name:
Address:
City: Zip:
Phone: Email: 
Reference #3:
Name:
Address:
City: Zip:
Phone: Email: 
Bank Reference:
Name:
Address:
Account Number:

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500 W. Wrightwood Ave.
Elmhurst, IL  60126
Phone:  1.800.535.2411  Fax:  1.630.758.1074
Email:  sales@albaxinc.com