Hart Industries Credit Application

Business Name

Phone

Street Address

City

State

Zip

Federal Tax ID Number

Tax Status

Type of Business

Years In Business

Has Firm or Any Principals Filed for Bankruptcy

Yes

Principal Name

Title

Home Street Address

Home City

Home State

Home Zip

Trade Reference 1 Name

Street Address

City

State

Zip

Phone

Trade Reference 2 Name

Street Address

City

State

Zip

Phone

Bank Reference Name

Bank Acct #

Bank Contact

Bank Contact Email

Bank Contact Phone

Method to Receive Invoices

Phone

Accounts Payable Contact

AP Email

AP Phone