Credit Application - RH Fastener Supply, Inc.

Instructions

You may download our credit application form here or complete the application below.

Credit Application

Business Name *

Amount of Credit Line Requested *

Bill To Full Mailing Address *

Ship To Full Street Address (If Different)

Phone Number *

FAX Number *

Federal Tax ID Number *

Tax Exemption ID *

Business Entity Structure *

Sole Proprietor

Partnership

Corporation

Date Business Established *

First Principal Full Name *

Title *

Second Principal Full Name (If Any)

Title

Inside Contact Full Name *

Inside Contact Phone *

Inside Contact Fax *

Invoice Receiving Preferences *

Mail

Fax

If Fax or Email is Selected, Input the Fax Number, Email Address, or put NONE *

Bank Reference

Bank Name *

Bank Phone Number *

Trade References

Trade Ref 1 Business Name *

Trade Ref 1 Phone Number *

Trade Ref 1 Fax Number

Trade Ref 1 Full Mailing Address *

Trade Ref 2 Business Name *

Trade Ref 2 Phone Number *

Trade Ref 2 Fax Number

Trade Ref 2 Full Mailing Address *

Trade Ref 3 Business Name *

Trade Ref 3 Phone Number *

Trade Ref 3 Fax Number

Trade Ref 3 Full Mailing Address *

File Attachments

Tax Exemption Form : Upload Here or Fax to (816) 587-8468 (Account Approval Requires a Copy of Your Tax Exemption Form)

Maximum upload size: 10MB

Scan and upload your your Tax Exemption form as one of the following file types: PDF, Jpg, Gif, Png, and Bmp. Or fax it to (816) 587-8468

Signature and Form Submission

Signature (Type Name In) *

Email Address *

Date *