Application for Credit

For questions regarding this application CALL 856-467-0500. If printing, FAX back to 856-467-4598.

Full Company Name:

Years in Business:

Billing Address:

City:

State:

Zip:

Shipping Address:

City:

State:

Zip:

Telephone:

Fax:

A/P Contact Name:

Are you EDI capable?

Yes No

Business Structure

Corporation Proprietorship Partnership or LLC

If Incorporated, State of incorporation:

Subsidiary:

Yes No

Division:

Yes No

Duns #:

If yes, Name & Address of Parent Company:

Has business / officer ever filed for bankruptcy?

Yes No

Name of Principal(s)

Title

Bank and / or Lender References (list all secured parties)

Name, Address, Contact Name

Phone

Account #

Trade References

Name & Address

Phone

Fax

I/We agree to make all payments within our 30-day terms with U.S. Drop Forge Co. If it becomes necessary to file a lien, suit or engage a collection agency or attorney, I/We agree to bear all expenses incurred (whether or not suit is filed), including but not limited to attorney fees, court costs, and a 12 % interest charge per month on all disputes Governed by the laws of New Jersey.

I hereby release any and all credit or financial information to U.S. Drop Forge Co.; by signing I am accepting your conditions of sales.

Email address (required):

Name:

Title:

Date: