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_______________

Address of Headquarters:

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

Are you tax exempt? ___Yes ___NO If yes please provide T/E No.________________(certificate)

Bank References: Account in name of ___Individual ___Business

Name ___________________________Branch_______________________

Address ______________________________Account No.______________

Telephone No. ________________________ Contact __________________

Trade References: Name at least four (4), include address, telephone number, account number and how long the account has been open.

1. ____________________________________________________

2. ____________________________________________________

3. ____________________________________________________

4. ____________________________________________________

Current Fastener Supplier __________________________________________________

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