Valley Fab Corp

Apply for Credit

You may apply for an in-house commercial account good for purchases at valleyfab locations, as well as purchases by phone and on our website. To apply, fill out the form below or call 000-000-1234.

General Information

Company *

Address *

Accts Payable Contact *

Phone *

Fax *

Email *

Years in business under this name *

Date *

Type of Business *

Credit line requested *

Bank Reference

Bank Name *

Address *

Checking Number *

Savings Number *

Loan Number *

Phone *

Fax *

Trade References (Six Required)

First Reference

Company Name *

Address of 1st Reference *

Contact of 1st Reference *

Phone of 1st Reference *

Fax of 1st Reference

Second Reference

Company Name of 2nd Reference *

Address of 2nd Reference

Contact of 2nd Reference *

Phone of 2nd Reference *

Fax of 2nd Reference

Account of 2nd Reference *

Third Reference

Company Name of 3rd Reference *

Address of 3rd Reference *

Contact of 3rd Reference *

Phone of 3rd Reference *

Fax of 3rd Reference

Account of 3rd Reference *

Fourth Reference

Company Name of 4th Reference *

Address of 4th Reference *

Contact of 4th Reference *

Phone of 4th Reference *

Fax of 4th Reference

Account of 4th Reference *

Fifth Reference

Company Name of 5th Reference *

Address of 5th Reference *

Contact of 5th Reference *

Phone of 5th Reference *

Fax of 5th Reference

Account of 5th Reference *

Sixth Reference

Company Name of 6th Reference *

Address of 6th Reference *

Contact of 6th Reference *

Phone of 6th Reference *

Fax of 6th Reference

Account of 6th Reference *

All statements made herein are true and accurate to the best of our knowledge. We agree that if Valleyfab, Inc. has to take action to collect our debt, we will pay for the costs of collection. We authorize Valleyfab, Inc. to make any and all inquiries necessary for action on this credit application. We hereby indemnify the above company from any liability resulting from this credit survey.

Name *

Date *