Credit Application

Please fill out the following form to apply for credit. When you are finished, click on the create button, and a form will be generated for you to print out. Once it is printed, please initial, sign, and date where needed. Then send the form in to the address provided on the form. Feel free to contact us at 1-800-899-9783. if you have any questions or problems with your application. Office hours are: Monday through Friday, 7:00 AM to 6:30 PM Central Time. Fax us 24 hours a day at (763) 689-5033.


Please be sure to fill out ALL FIELDS MARKED WITH AN ASTERISK. *

Company Name:  *
Billing Address:  *
City:  *
State: *   Zip:  *
Number of years in business:   Years at above address:  
Please check one:     Partnership     Sole Proprietorship     Corporation    
Is business listed with Dun & Bradstreet?  Yes   No    D & B Number:  
Have you or your business filed bankruptcy in the last 5 years?  Yes   No
Name of officers, partners or owners:  
Business' Bank:
Officer:
City:
State:    Zip: 
Fax:

------ Vendors with which you do business (list 3) ------
VENDOR 1
Name: * Contact:   *
City: *
State: *   Zip:  *
Fax:
VENDOR 2
Name: * Contact:   *
City: *
State: *   Zip:  *
Fax:
VENDOR 3
Name: * Contact:   *
City: *
State: *   Zip:  *
Fax:

Please click to proceed to the printable view and print the form by using your browser's menu and fax it to us for further processing. The processing time is two to three weeks.