HYPEMILL:SWANSON:CREDITAPP

CUSTOMER INFORMATION AND CREDIT APPLICATION Please complete all sections Revised 1/21/2015

DATE

CUSTOMER NUMBER (Swanson Use Only)

211 Ontario Street, Frankfort, IL 60423

To ensure a strong long term relationship, we ask that you fully complete this Customer Information and Credit Application Form. It must be signed and returned to the Credit Department: Attn: Tori Panozzo before your orders can be considered. This agreement governs all sales of Swanson Tool Co., Inc. products and services on terms and conditions set forth by Swanson Tool Co., Inc. in conjunction with the confirmation issued with each order. If a section is not applicable please indicate with N/A. Please allow 7 to 10 working days for processing. BILL TO SHIP TO BUSINESS NAME (LEGAL OWNERS/APPLICANT) NAME OF ACCOUNT STORE NUMBER

TRADE NAME (D.B.A.)

ADDRESS

ADDRESS

CITY CODE

STATE

ZIP

CITY

STATE

ZIP CODE

WAREHOUSE CONTACT

PHONE NUMBER

PHONE NUMBER

FAX NUMBER

FAX NUMBER

BUSINESS INFORMATION

TYPE OF BUSINESS:  SOLE PROPRIETORSHIP

 CORPORATION (State:

_)

 FRANCHISE OF

 PARTNERSHIP

 L.L.C OR  L.C.

 LIMITED PARTNERSHIP

PARENT CORPORATION (If Subsidiary, Affiliate, or Division)

BUILDING/FACILITIES  OWNED

HOW LONG AT PRESENT LOCATION?

 LEASED

 RENTED

 HOME-BASED

NAME AND TITLE OF ACCOUNTS PAYABLE CONTACT PERSON

PHONE NUMBER OF ACCOUNTS PAYABLE CONTACT PERSON

E-MAIL ADDRESS OF ACCOUNTS PAYABLE CONTACT PERSON FOR PDF INVOICES

FOR U.S. COMPANIES: FEDERAL TAX IDENTIFICATION NUMBER

FOR CANADIAN COMPANIES: P.S.T. EXEMPTION NUMBER

DATE BUSINESS STARTED

ANNUAL SALES

PREVIOUS CUSTOMER Y N CUSTOMER #

NUMBER OF STORES

PRINCIPAL (OFFICERS OR PARTNERS) - IF ADDITIONAL PLEASE ATTACH NAME TITLE NAME

TITLE

MAILING ADDRESS

MAILING ADDRESS

CITY

STATE

ZIP CODE

CITY

STATE

ZIP

DIRECT PHONE NUMBER

EMAIL ADDRESS

DIRECT PHONE NUMBER

EMAIL

ADDRESS

BUYERS - IF ADDITIONAL PLEASE ATTACH NAME TITLE

NAME

TITLE

MAILING ADDRESS

MAILING ADDRESS

CITY

STATE

ZIP CODE

CITY

STATE

ZIP

DIRECT PHONE NUMBER

EMAIL ADDRESS

DIRECT PHONE NUMBER

EMAIL

ADDRESS

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