Credit Application

    General Information  
  Business Name: *  
  Phone: *  
  Fax: *  
  Email: *  
    Billing Information  
  Billing Address: *  
  Billing City: *  
  Billing Zip: *  
  Billing State: *  
    Delivery Information  
  Delivery Address:  
  Delivery City:  
  Delivery Zip:  
  Delivery State:  
    Credit Information  
  Tax Identification Number: *  
  Owner/Principals Names: Title:  
   
   
   
  Accounts Payable Contact Title:  
   
  Terms Requestion:    
  Proforma COD Net 30 Credit Card  
    Bank Information  
  Bank Name  
  Bank Account number  
  Bank Contact  
  Bank Address  
  Bank City  
  Bank Zip  
  Bank State  
    Trade References  
  Reference 1    
  Company Name:  
  Address  
  Telephone  
  Reference 2    
  Company Name:  
  Address  
  Telephone  
  Reference 3    
  Company Name:  
  Address  
  Telephone  
  Reference 4    
  Company Name:  
  Address  
  Telephone  
  Reference 5    
  Company Name:  
  Address  
  Telephone  
   
 
  I would like to place an order immediately, please contact me.  
  Note:
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Fabricade Fabrics
Phone:800-645-5540 Fax: 631-563-7489
e-mail: sales@fabricade.com
5050 Veterans Highway, Holbrook, NY 11716