       
APPLICATION FOR CREDIT Company Name:______________________________________________ Address Line 1: ___________________________________________________ City/State/Zip Code:________________________________________________ Telephone #:_________________________ Fax Number:________________________ AP Contact:_______________________ Email: _____________________________ Dun & Bradstreet #:______________________________________________ *If exempt from Pennsylvania sales tax, please include a completed exemption form. Bank Information:Name, City & State:_______________________________________________________Account Number(s): _____________________________________________________Account Contact & Phone #:_______________________________________________Credit References (please include Fax #s): Company Name/Contact:________________________________________________Telephone #:_____________________________Fax#:____________________________Company Name/Contact:________________________________________________Telephone #:____________________________Fax#:_____________________________Company Name/Contact:________________________________________________Telephone #:____________________________Fax#:_____________________________PLEASE FAX BACK TO (610) 889-0484
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