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Gross Automation
Linecard in PDF
 

Credit Application
Please provide all information requested.
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Web Site:
Business Type: Sole Proprietorship  Partnership  Corporation
Tax-Exempt #:

Personnel

Accounts Payable Contact:
 

Telephone:
 

Fax:
 

Email:

Purchasing Contact:
 

Telephone:
 

Fax:
 

Email:
Bank Reference  
Bank Name:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:
Trade References  
Reference #1  
Company:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:
Reference #2  
Company:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:
Reference #3  
Company:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:

It does take 2-3 days to acquire all of the information from your
references.  Please make sure that the references are up to date,
INCLUDING FAX NUMBERS, this will shorten the hold time of your order!

 
 

Gross Automation, 3680 N. 126th St., Brookfield, WI 53005
PH: 262-252-1600 Fax: 262-252-1616