Our terms are NET 15 and discounts may be cancelled on all bills that exceed 30 days.  A

Credit Application

Company Name: ________________________________________________

Address: _____________________________________________________

City: __________________________ State: ______ Zip Code: ___________ 

Email: ________________________________

Phone: _______________________________

Fax: _________________________________

Bill To Address: ________________________________________________

_____________________________________________________________

Website: ______________________________________________________

President: _____________________________________________________

Vice President: _________________________________________________

Acct. Payable Rep.: ______________________________________________

Phone: __________________________ Email: ________________________

Tax ID#: _________________________

Years at Location: ________ Years Under This Name: __________

Corporation: ________  Company: _______ Proprietorship: _______

Partnership: _________ Other: _____________________

If Subsidiary, Name, City, and State of Parent: _________________________

_____________________________________________________________

Type of Business: ________________________________________________

REFERENCES

Bank Name: ____________________________________________________

Account No.: ___________________________________________________

Address: _______________________________________________________ 

Contact Name: __________________________Phone: __________________

Email: _________________________________ Fax: ____________________

1. Vendor Name: ____________________________________________

Contact: ________________________ Email: _____________________

Address: ___________________________________________________

Phone: _________________________ Fax: _______________________

2. Vendor Name: _____________________________________________

Contact: ______________________ Email: ________________________

Address: ___________________________________________________

Phone: __________________________ Fax: _______________________

1. Transportation Srvc Name: ___________________________________

Contact: __________________________ Email: ____________________

Address: ___________________________________________________

Phone: _____________________________ Fax: ___________________

2. Transportation Srvc Name: __________________________________

Contact: __________________________ Email: ____________________

Address: ___________________________________________________

Phone: _____________________________ Fax: __________________

FSD Representative: _________________________________________

The undersigned represents the above information is true and correct as the date thereof:

1.  All accounts are due and payable no later than fifteen (15) days from the date of the invoice, in accordance with the ICC Regulations.

2.  Our terms are NET 15 and discounts may be cancelled on all bills that exceed 30 days.

3. The undersigned authorizes all banks, vendors, and transportation services to release information to FSD that FSD may require to reach a credit decision.

Date: ________ Signed By: ______________________________________

Title: _______________________________________

Fax to FSD: (626) 852-0070 or Mail to:
416 South Vermont; Glendora, CA 91740 (626) 650-6522