AUTOMATED FASTENING SYSTEMS

5700-F Sunnyside Ave. Beltsville MD 20705

Tel-301-507-6200 Fax-301-507-6205

www.automatedfastening.com E-mail: sales@automatedfastening.com

CREDIT APPLICATION

Date ______________________

Name of Business________________________________________________________

Address_________________________________________________________________

Phone No.__________________Fax No.__________________E-mail_______________

Bill to Address:_____________________________________________________

Type of Business ___ Corporation ___ Partnership ___ Sole Proprietor

If Corporation, State incorporated: ____________________ Date____________

Name, Home Address, Telephone Number and Title of Officers, Partners or Sole Owner:

1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

Accts. Pay. Contact _________ Do you use Purchase Order #’s? ___Yes ___No

Tax Exempt?___Yes___No If yes, please provide Tax Exempt No.____________

Bank References: Account in name of ___Individual ___Business

Name _________________________________Branch_____________________

Address______________________________Account #____________________

Telephone No.____________________ Contact__________________________

Trade References: Name at least four (4), include telephone and Fax number

1. __________________________________________________________

2. __________________________________________________________

3. __________________________________________________________

4. __________________________________________________________

Current Fastener Supplier___________________________________________

(Please Complete Page 2)