Form

Credit Application Request

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Credit Application

Company Name *
AP Contact Person *
Corporate Structure *
Company Phone *
Fax Number
Email Address for Invoices *
Website URL *
Billing Address *
Shipping Address *
Year Established *
Federal EIN *
Type of Business *
Taxable?
*If no, please attach Exemption Certificate.*
Exemption Certificate

Bank Reference

Bank Name *
Address *
Accounts *
Bank Phone *

Trade References

Company Name #1 *
Address #1 *
Phone Number #1 *
Company Name #2 *
Address #2 *
Phone Number #2 *
Company Name #3 *
Address #3 *
Phone Number #3 *
quote

PSB Industries Inc. have been using products provided by Sullivan Supply for more than 25 years. Their experienced Sales team, competitive pricing, on time delivery and support after the sale are seco

Al Wassel, President
PSB Industries Inc.
Erie, PA