Credit Application

Credit Application

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To submit the information for your Credit Application, please complete the form below.

Email or Fax

If you prefer to email or fax the information to us, please complete our Credit Application form in PDF. Either open the PDF and fill in the form digitally or print the form and fill it in manually. Download form.

Send the PDF file to us by email or fax.

Customer Information

Legal Name of Company: *

Operating Name (if different):

Mailing Address

Address: *

City: *

Province/State: *

Country: *

Postal/State: *

Phone: *

Fax:

Shipping Address (If different than mailing address)

Shipping Address:

City:

Province/State:

Country

Postal/Zip Code:

Phone:

Fax:

Type of Business: *

Sole Proprietor

Partnership

Corporation

Other (Please specify below)

Principal Officers & Contacts

Principal Officer

First Name: *

Last Name: *

Title: *

Email Address: *

Principal Officer 2

First Name:

Last Name:

Title:

Email Address:

Principal Officer 3

First Name:

Last Name:

Title:

Email Address:

Accounts Payable Contact

First Name:

Last Name:

Phone:

Email Address:

Fax:

Trade References

(We require information from 3 firms from whom you are currently purchasing on open account.)

Trade Reference 1

Company Name: *

First Name:

Last Name:

Address: *

City: *

Province/State: *

Country: *

Postal/Zip Code: *

Phone: *

Fax:

Trade Reference 2

Company Name: *

First Name:

Last Name:

Address: *

City: *

Province/State: *

Country: *

Postal/Zip Code: *

Phone: *

Fax:

Trade Reference 3

Company Name: *

First Name:

Last Name:

Address: *

City: *

Province/State: *

Country: *

Postal/Zip Code: *

Phone: *

Fax:

Bank Reference

Bank Name: *

Branch: *

Address: *

City: *

Province/State: *

Country: *

Postal/Zip Code: *

Phone: *

Fax: *

Account Number: *

Approximate Value of Initial Order: *

Maximum Credit Requested: *

Payment Terms

Payment Terms: All invoices are due within 30 days from the date of the invoice. Orders are accepted by Stromag on the strict understanding that customers will pay all service charges that may be added to their account due to late payment. Service charges at the rate of 2.5% per month (30% per year) will be added to overdue accounts.

By submitting this information, I agree that I understand and accept the above terms and have provided true information to the best of my knowledge, and have retained a copy of this agreement for my records. I further authorize the above cited references to supply such information as may be required to determine our credit capabilities.

I agree that Stromag has permission to contact me.

Date: *

First Name: *

Last Name: *

Title: *

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Email or Fax

Customer Information

Mailing Address

Shipping Address (If different than mailing address)

Principal Officers & Contacts

Principal Officer

Principal Officer 2

Principal Officer 3

Accounts Payable Contact

Trade References

Trade Reference 1

Trade Reference 2

Trade Reference 3

Bank Reference

Payment Terms

Contact

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