Valley Tool, Inc

Credit Application

Please fill out the following form for account credit.

* All fields are mandatory.

Bill To:
Name:
Address:
City:
State:
Zip:
Phone:

Ship To: - Check if same as Bill to:
Name:
Address:
City:
State:
Zip:
Phone:

Company Information:
President / Owner:
Purchasing Agent:
Accounts Payable Contact:
Company Type:
Tax ID or SS#:
Are you tax exempt? Yes No (More Info/Form)
Tax Exempt # (Please send copy of tax exempt form or resale certificate):
Number of Employees:
Type of Shop:

Bank Information:
Bank Name:
Bank Address:
Bank City:
Bank State:
Bank Zip:
Bank Contact:
Bank Phone:

Credit Reference #1:
Company Name:
Contact:
Address:
City:
State:
Zip:
Phone:
Fax:

Credit Reference #2:
Company Name:
Contact:
Address:
City:
State:
Zip:
Phone:
Fax:

Credit Reference #3:
Company Name:
Contact:
Address:
City:
State:
Zip:
Phone:
Fax:

Preferred method to receive invoices: Email: Fax:

Email:

Fax:

Contact:

VT

Valley Tool, Inc

Credit Application