Credit Application Form
 

Please use this form to apply for a new account with Crystal Lake Manufacturing, Inc. by mail or fax  You will receive an E-mail after submission with details of your account.  Follow-up by regular mail or phone may be necessary. Note: Orders will be cash in advance until credit is approved.
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 Enter Your Company Information

Company Name:______________________________

Company Phone:______________________________
Street Address:______________________________ Mailing Address:______________________________
City, State Zip:______________________________ City, State Zip:______________________________
Your Name:______________________________ Best Time to Call:______________________________
E-Mail Address:______________________________ Your Phone:______________________________
Your Phone:______________________________ Position/Title:______________________________

Enter Trade Reference Information:

First Reference

Name: ______________________________    Address: ______________________________

Account Number: _________________________ Point of Contact:_________________________

Phone Number:  ______________________________(xxx) xxx-xxxx

Second Reference

Name: ______________________________    Address: ______________________________

Account Number: _________________________ Point of Contact:_________________________

Phone Number:  ______________________________(xxx) xxx-xxxx

Third Reference

Name: ______________________________    Address: ______________________________

Account Number: _________________________ Point of Contact:_________________________

Phone Number:  ______________________________(xxx) xxx-xxxx

Bank Reference

Bank Name: ______________________________   Address:______________________________

Account Number: _________________________   Point of Contact:_______________________

Phone Number: ______________________________   (xxx) xxx-xxxx

Mail this form to: Crystal Lake Manufacturing, Inc., P.O. Box 159, Autaugaville, Alabama 36003-0159

or

Fax this form to: Crystal Lake Manufacturing, Inc. (334) 365-3332