February 4, 2012
Credit Application Form
pdf Submit your credit application form online; mandatory fields are marked with an asterisk.
If you prefer to submit the Steel Plus Distribution Credit Application form by fax (450) 629-8557; please click here to download the document.
Company Information
Name *:
Type ( Inc, LLC, etc ) *:

Billing Address *:
Year Business Established :

City *:
Name of Owner *:

State *:
 

Zip Code *:

Phone *:
Are you an affiliate company? *:
Yes, Indicate Parent Company name below

Fax *:
 
No

 
 
 

Shipping Address
Receiving Information

Same as billing address? *:
Yes No, Please enter address below
Customs broker *:

Shipping Address :
Carrier *:

City :
Receiving Days :

State :
Receiving Hours :

Zip Code :
Unloading Requirements :

 
 
Packaging Requirements :

Person to be contacted :
Person to be contacted *:

Purchasing Agent Information
Accounts Payable Agent Information

Purchasing Agent Name *:
AP Name *:

Email *:
Email *:

Phone *:
Phone *:

Fax :
Fax :

Bank Information
Name *:

Address *:

City *:

State *:

Zip Code *:

Phone *:

Fax *:

Bank Contact *:

Credit
Credit Limit Requested *:


Sales Tax Permit No. :

(If non-taxable, copy of permit is required)


Dun & Bradstreet Member ID No. :

Suppliers/Trade References
Name *:
Name *:

Address *:
Address *:

City :
City :

State :
State :

Zip Code :
Zip Code :

Phone *:
Phone *:

Fax *:
Fax *:

Credit limit :
Credit limit :

Average purchase (year or month) :
Average purchase (year or month) :


Name *:
Name :

Address *:
Address :

City :
City :

State :
State :

Zip Code :
Zip Code :

Phone *:
Phone :

Fax *:
Fax :

Credit limit :
Credit limit :

Average purchase (year or month) :
Average purchase (year or month) :