Credit Application
Business Name:
*
Phone:
*
Fax:
*
(please do not use dashes in phone number and fax number)
E-mail:
*
Billing Information
Billing Address:
*
Billing City:
*
Billing Zip:
*
Billing ST:
*
Delivery
Information
Delivery Address:
Delivery City:
Delivery Zip:
Delivery ST:
===========================================
Tax Identification Number #
*
Owner/Principals Names: Title:
Accounts Payable Contact: Title:
Terms Requesting:
PROFORMA
COD
NET 30
Credit
Card
Bank Information:
Bank Name:
Bank Acct #:
Bank Contact:
Bank Address:
Bank City:
Bank Zip:
Bank ST:
Trade References:
Reference 1
Company Name:
Address:
Telephone:
(please do not use dashes in phone number)
Reference 2
Company Name:
Address:
Telephone:
(please do not use dashes in phone number)
Reference 3
Company Name:
Address:
Telephone:
(please do not use dashes in phone number)
Reference 4
Company Name:
Address:
Telephone:
(please do not use dashes in phone number)
I would like to place an order immediately, please contact me..
Sample Book Request:
Upholstery
Drapery
Both
NOTE:
Line Items marked with (
*
)
are required fields. Please scroll up and make
sure they are filled out
Fabricade
Phone:800-645-5540 Fax: 631-563-7489
e-mail: sales@fabricadefabrics.com
5050 Veterans Highway
Holbrook, NY 11716