Application for Credit
Company Name
 Phone Number
Address
 Year Established
City
 State
 Zip
 Fax Number
Authorized Purchasers
Owner's Name
 Phone Number
Residential or Main Office Address

Partnership Corporation Individual Other
BANK REFERENCE
Bank Name
 Phone
 Fax
Mailing Address
 Contact
City
 State
 Zip
 Account Number

TRADE REFERENCES (List three currently extending you credit)
1) Name
 Phone
 Fax
Mailing Address
 Account #

2) Name
 Phone
 Fax
Mailing Address
 Account #

3) Name
 Phone
 Fax
Mailing Address
 Account #

WE ARE TAX EXEMPT: YES NO
STATE CERTIFICATE #
 STATE OF ISSUE

PURCHASE IS FOR: TAX EXEMPT INSTITUTION RESALE

(I) (WE) AGREE TO NOTIFY YOU IMMEDIATELY OF ANY CHANGE IN OWNERSHIP AND PAY ALL INVOICES DUE GRAY SUPPLY COMPANY ACCORDING TO YOUR TERMS OF NET THIRTY DAYS.

(I) (WE) AGREE THAT THE CONCERNS LISTED ABOVE HAVE PERMISSION TO RELEASE REQUESTED CREDIT INFORMATION TO GRAY SUPPLY COMPANY.
SIGNED TITLE DATE

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