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Credit Application


Company Information
* Indicates required fields.
 
*Email Address: 
Company Name:
Company Address:
City: State: Zip:
Telephone:
Fax:
Type of Business:
Years in Business:

Partners or Corporation Officers
Name
Title
Telephone
 

Bank References
Bank Name & Address
Account Number (s)
Contact Name & Phone

Trade References
(must include fax numbers)
1.
Ph:
fax:
2.
Ph:
 fax:
3.
Ph:
 fax:
4.
Ph:
 fax:
5.
Ph:
 fax:
 

I agree to pay all invoices on time or pay 1.5% per month service charge on past due amounts, and pay legal costs and attorney fees if collection of account is necessary. I authorize Golden West Machine Inc. to contact any or all of the above listed banks and trade references for credit verification purposes.

I certify that the above information is true. This information is to be used only for opening an account.