Credit Application

Please complete this credit application in its entirety in order to expedite the application process. You can fill this form out online or you can print it out and fax it to us at (208) 734-7222. Please ensure that you have read the Terms & Conditions page prior to submitting this form. You can attach additional documentation to this application at the bottom of the page.

* = Required Information
General Information
Name: *
Division of:
Shipping Address *
Shipping City: *
Shipping State/Province: *
Shipping Zip: *
Shipping Telephone: *
Shipping Fax: *

Billing Address: *
Billing City: *
Billing State/Province: *
Billing Zip: *
Billing Telephone: *
Billing Fax: *
Web Site Address: *
Legal Structure of Business:
Length of Time in Business: *
D&B Number: *
Sales Tax Resale Number:
Resale Number for the State of:  
  (Actual resale certificate must be faxed or attached to this document for CA & UT)
   
Owners/ Officers
Name Title
* *
Phone Number Email
* *

Name Title
Phone Number Email

Name Title
Phone Number Email

Name Title
Phone Number Email
   
Please list your accounts payable personnel who will manage this account
Name Title
* *
Phone Number Email
* *

Name Title
Phone number Email
   
Bank References
Name AccountNumber
Contact Name Phone Number

Name Title
Contact Name Phone number
   
Trade References
Name AccountNumber
*  
Contact Name Phone Number Fax Number
* *

Name Title
*  
Contact Name Phone number Fax Number
* *

Name Title
*  
Contact Name Phone number Fax Number
* *
 
Attach additional documents
Documents:
(Attach actual resale certificate for CA and UT)

We hereby authorize Seastrom Manufacturing Co., Inc. to contact the references provided as a part of this application along with all others provided at future dates. We authorize you to request and update credit reports, trade reports, industry reports, trade references, etc. at any time that we have an account with you.
 
Terms and Conditions
 
Name: *
Signature (faxed forms only)  
Title: *
Date: *