Application For Credit

*PLEASE FILL OUT THIS FORM COMPLETELY TO INSURE TIMELY PROCESSING OF YOUR REQUEST*

Business Name

Line of Credit Requested

Billing Address

City

State

Zip

Shipping Address

Business Phone

City

State

Zip

Fax (optional)

Owner(s) Name

Owner(s) Name (optional)

Sales Email Address

Accounting Email Address

Federal Tax ID

Purchase Order Numbers Required: Yes No

PLEASE LIST TRADE REFERENCES

We require at least three trade references. Please include fax and phone numbers of the accounting department. References can not be completed without fax numbers.

Company

City

State

Phone Number

Fax Number

Company

City

State

Phone Number

Fax Number

Company

City

State

Phone Number

Fax Number

TO OBTAIN CREDIT, PLEASE SIGN BELOW

In consideration for credit being extended by Hydraulic Specialties Inc, the undersigned hereby jointly and severally guarantees complete and timely payment of all liabilities and obligations by the applicant whether the applicant is an individual, a proprietorship, a corporation or other entity. Furthermore, undersigned agrees to pay any service charges incurred in the amount of 1.5% per month for any balance remaining unpaid beyond 30 days. Applicant’s signature attests financial responsibility, ability, and willingness to pay invoices in accordance with above terms.

Electronic Signature