Credit Application

Sales Desk

1-800-523-2367

Extension "3"

for Chain Sales

(or 1-219-696-6411)

Fax: 219-696-6413

CREDIT APPLICATION

Note: In order to cover additional handling and credit risk we must add 10% to prices if using Net 30 day terms.

Printable Version

Names and Addresses
Person completing this form:
Company Name
Address
Address
City
State
Zip
E-mail address
Ship to Address (if different)
Company Name
Address
Address
City
State
Zip
Phones
Purchasing
Shop
Accounts Payable
Main Fax
Business Information
Corporation Proprietorship Partnership
Owner or President
Title
Social Security or Federal ID Number
Years in Business
Nature of Business
Bank
Bank Name
Bank Address
	(we may call you for you account number)
Are you subject to sales tax in Indiana	Yes No
Are you subject to sales tax in Illinois	Yes No
( Indiana or Illinois exempt customers will be asked to sign a tax exemption certificate)
Credit References
We need three current sources of supply with which you do business with on an open account. Please do not use banks, credit card companies or secured loans as references.

Name	Phone	Fax	Acct #

Terms of payment are net 30 days. Past due invoices are subject to a 1-1/2% monthly service charge. Credit privileges are revoked if consistently past due. Costs of collecting money due and owing on this account, including court costs and attorney fees, will be charged to the debtor. In making this application, the customer agrees to these terms.

Privacy Policy

1st Chain Supply

a division of MPI

P.O. Box 368

797 W. Commercial Ave.

Lowell, IN 46356

Printable Version

Questions? Call us toll free
1-800-523-2367

(press extension "3")

Monday thru Friday 8:00am to 4:30pm CST

24 Hour Fax Lines 1-219-696-6413