RLH Credit Application

Credit Application
BUSINESS INFORMATION
Company name
AP Contact
Phone

Area CodePhone Number
Fax

Area CodePhone Number
Email
example@example.com
Billing Address
Ship to Address
Date business commenced

MonthDayYear
Date
D&B #
Federal ID #
Sales Tax ID #
If applicable, send tax certificate. Sales tax will not be credited prior to receiving exempt form.
Tax Certificate File Upload

Cancelof
Bank Reference
Account #
Bank Contact
Phone

Area CodePhone Number
Fax

Area CodePhone Number
PO Required

YesNo
Owner Name
Address
Owner Name
Address
Owner Name
Address
BUSINESS / TRADE REFERENCES

Provide up to three
Company name
Address
City State ZIP
Phone

Area CodePhone Number
Fax

Area CodePhone Number
Email
example@example.com
Type of account
Other
Company name
Address
City State ZIP
Phone

Area CodePhone Number
Fax

Area CodePhone Number
Email
example@example.com
Type of account
Other
Company name
Address
City State ZIP
Phone

Area CodePhone Number
Fax

Area CodePhone Number
Email
example@example.com
Type of account
Other
SIGNATURE
Printed Name & Title
Authorized Signature

Clear
Date

MonthDayYear
Date
Please also include W-9 Form & Bank Reference with submission.

Standard Terms are Net 30 Days
W-9 File Upload

Cancelof
Bank Reference File Upload

Cancelof
Should be Empty:

Credit Application