Credit Application

Special Offers

Please fill out this form and Submit to process your Credit Application

Date of Application *

Business Name *

Complete Address *

Telephone Number *

Email *

How Long Has Business Been in Operation? *

Will Company Accept Back Orders?*

Yes

Name of Owner (or Officers if corporated)

PLEASE CHECK ONE BOX

Sole Proprietorship

Partnership

Corporation

Bank Name*

Bank Address*

Bank Phone No.*

Bank Account No.*

Name and Account Numbers of Current Suppliers

1.Name of Supplier*

Account #*

Telephone #*

2. Name of Supplier*

Account #*

Telephone #*

The undersigned expressly agrees to make payment in full to FMF Glass Hardware for all purchases in accordance with the terms of the sale.

It is agreed that My/Our account may become Credit Card (without being notified) if I/We fail to pay within the stated terms. Should the undersigned default in any such payment, the undersigned agrees to pay a late service charge on any amounts in default at the maximum permitted by law. This agreement shall become effective when accepted by an authorized FMF Glass Hardware representative. The undersigned hereby authorizes the above mentioned banks and business references to release the information requested by FMF Hardware.

Form Completed By *

Title*

Telephone *

Email *

I warrant that the foregoing information is true and correct and realize it will be relied upon in the granting of future credit.