EmailMe Form - New Account Application

Company Name *

Name(s) of Principals *

Phone

### - ### - ####

Business Type

Corporation

Partnership

Sole Proprietorship

Please list state of Corporation if applicable:

Year Business was Established *

Annual Sales *

Number of Employees *

Federal Tax ID or SSN *

D&B Number *

SIC Code

Credit Amount Requested *

$2,000

$5,000

$10,000

Tax Exempt *

Yes

No

If yes, certificate must be uploaded.

PO Required *

Yes

No

File Upload

Billing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Shipping Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Services Requested from AFT *

Fasteners and/or Industrial Supplies

Plating or Metal Finishing

Both

Other

Bank Reference

Bank Name *

Bank's Phone # *

Bank's Address *

Bank Account # *

Trade Reference #1

Trade Reference #1 - Name *

Trade Reference #1 - Phone # *

Trade Reference #1 - Address *

Trade Reference #1 - Account # *

Trade Reference #2

Trade Reference #2 - Name *

Trade Reference #2 - Phone # *

Trade Reference #2 - Address *

Trade Reference #2 - Account # *

Trade Reference #3

Trade Reference #3 - Name *

Trade Reference #3 - Phone # *

Trade Reference #3 - Address *

Trade Reference #2 - Account # *

I represent that the above information is true and is given to induce AFT to extend credit to the applicant. My company and I authorize AFT to make such credit investigation as it sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose any and all information concerning the financial and credit history of my company and myself.

Signature

Clear

Printed Name *

Email *

Title *

Date Time

MM / DD / YYYY