CREDIT APPLICATION            
 * Required field
 Company Name: * 
 Business Owner(s) Name:  
 Primary Contact: * 
 Email Address:  
 Billing Address:   
 City, State, Zip:  ,  
 Shipping Address:   
 City, State, Zip:  ,  
 Phone Number: *        ext. 
 Fax Number:       ext. 
 Website Address: 
 Resale Number: 
 Federal Tax Id: *  (XX-XXXXXXX)
OR
 Social Security Number: *   (XXX-XX-XXXX)
 
   
 Please provide three trade references:   
    
 Company 1 Name: 
 Billing Address:   
 City, State, Zip:  ,  
 Phone Number:       ext. 
 Fax Number:       ext. 

 Company 2 Name: 
 Billing Address:   
 City, State, Zip:  ,  
 Phone Number:       ext. 
 Fax Number:       ext. 

 Company 3 Name: 
 Billing Address:   
 City, State, Zip:  ,  
 Phone Number:       ext. 
 Fax Number:       ext. 

 Remarks: 
 
   


KDL HARDWARE SUPPLY, INC.
P.O. 24746 | SEATTLE, WASHINGTON 98124-0746
COPYRIGHT 2006

Toll-Free Telephone: 1.800.926.7716 | Fax: 1.800.524.9305