800-814-8444

Customer Credit Application

Full Name

Business Name

Date

Business Address

City

State

Zip Code

Business Phone

Business Fax

Federal Tax #

State Tax #

DUNNS #

How long in business at this address?

If less than one year, please give previous address?

Parternship or Proprietorship

Individual 1 - Name

Home Address

Individual 2 - Name

Home Address

Corporation

Corporation Name

President

Vice President

Secretary

Treasurer

Principal Suppliers

Supplier 1

Corporation Name

Phone

Address

Supplier 2

Corporation Name

Phone

Address

Supplier 3

Corporation Name

Phone

Address

Does company own real property?

Bank

Branch

Bank Phone

Agreement

We herein make application to Falcon Stainless Inc. for credit and/or to update and reconfirm our existing account and balance with Falcon Stainless Inc.

Authroized Agent

Email Address

By submitting this application I acknowledge that the above information entered is correct