Credit Application | Exotic Automation & Supply

Click here to download a copy of our credit application, or simply fill out the form below. If you fill out the online form please attach a copy of the Michigan Sales and Use Tax Certificate of Exemption form.

REQUIRED

Legal Name(Required)

Trade Name(Required)

Credit Amount Requested(Required)

Billing Address(Required)

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

Number of Employees(Required)

Phone(Required)

Fax

Federal ID #(Required)

Year Business Started(Required)

Annual Sales Volume(Required)

Dun & Bradstreet Number

President / Owner(Required)

First Last

AP Contact(Required)

First Last

AP Email(Required)

AP Phone(Required)

Email or Fax Invoices to(Required)

Purchase Orders Required?(Required)

Yes

Freight Collect Account(Required)

Doing Business As(Required)

Corporation

Partnership

Sole Proprietorship

LLC

BANK REFERENCE

Complete or Attach

Bank

Phone

Fax

Contact

First Last

Checking Account #

Savings Account #

CREDIT REFERENCE

List only credit references that have given you an open line of credit

(1) Name

Account #

Phone

Fax

Address

Street Address City State / Province / Region ZIP / Postal Code Country

(2) Name

Account #

Phone

Fax

Address

Street Address City State / Province / Region ZIP / Postal Code Country

(3) Name

Account #

Phone

Fax

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Name(Required)

First Last Title

Date(Required)

Please attach any additional documents below.(Required)

Tax Forms, Credit References, etc.

Drop files here or

Max. file size: 512 MB.

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