Credit Application

* denotes a required field.

Today's Date: *

Status: *

Order Pending

Current Cash Customer

Initial Credit Amount Required: *

Years in Business:

Company Name: *

Website: *

Billing Information

BILL TO Address: *

City: *

State: *

Zip Code: *

Shipping Information

SHIP TO Address: *

City: *

State: *

Zip Code: *

President:

Vice President:

Owner:

Controller or Accounting Manager: *

Accounts Payable Contact

Accounts Payable Contact: *

Email Address: *

Phone Number: *

Fax Number: *

Fax Number:

Email Address:

Tax Exempt NO. (if applicable):

Bank Information

Zip Code:

Bank Name: *

Bank Phone Number: *

Address:

City:

State:

Bank Officer:

TRADE REFERENCES

Please include PHONE and FAX NUMBERS and COMPLETE ADDRESSES. Fax numbers are necessary as most companies will not provide credit information over the phone. Also, some companies require that the request be mailed to them. ACCOUNT NUMBERS are also very helpful. These things are all necessary to complete the credit approval process in a timely manner.

The following are not valid references: Financial Institutions, Utility, Rental and/or Leases, and Revolving Credit Card Accounts.

Reference 1

Company Name: *

Fax Number: *

Phone Number: *

Address: *

City: *

State: *

Zip Code: *

Account Number:

Reference 2

Company Name: *

Fax Number: *

Phone Number: *

Address: *

City: *

State: *

Zip Code: *

Account Number:

Reference 3

Company Name: *

Fax Number: *

Phone Number: *

Address: *

City: *

State: *

Zip Code: *

Account Number:

Additional References:

Additional Forms

In addition to the online form, a State Tax Exemption Form and a State Tax Resale Form must be filled out and submitted. Please use the links below to download the forms.

Once you have completed and signed the forms, you may upload them in the spaces provided below OR you may email them to swilson@4starhose.com OR you may fax them to 214-357-4427. The application is not complete without these forms.

Tax Exemption Form:

Tax Resale Form: