Credit Application
Fax # 216-931-7707
New Customer
Existing Customer Update
The following information is required to establish credit with State Industrial Products. For prompt approval, complete all areas of this form before pressing the submit button below.
Billing Address
Business Name:
Address:
City, State, Zip:
Phone No.
(
)
How Long in Business?
Years
Months
Business Organization:
Sole Proprietorship
Partnership
Corporation
Other
Dun & Bradstreet Number:
Fax Number:
Business SIC Code:
E-Mail Address::
Sales Tax Exemption #
Federal Tax ID #:
(NOTE: Failure to supply tax exemption number and provide a copy of the certificate will result in assessment of sales tax)
Purchase Order # Required:
Yes
No
Parent Company name and address if subsidary (or if business is DBA)
Name
City
State
Phone
1st Trade Reference
2nd Trade Reference
3rd Trade Reference
Sold To Address (If different than above):
Business Name:
Address:
City, State, Zip:
Phone No.
(
)
Contact Name:
Name of person preparing credit application:
-
I authorize State Industrial Products to use the information above for credit checking purposes.