L. Everitt Industrial Supply, Inc.
Credit Application
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Application For Credit
Date:
Taxable:
Non-Taxable:
Permit #:
Company Name:
Mailing Address:
Street Address
City/State:
Zip:
Telephone #:
Fax #:
Name of President, Treasurer, Owner or Partner:
Home Address:
Are you a:
Corporation
Partnership
Proprietorship
If a Corporation, give year and state incorporated:
If other, give principal name and social security #:
Bank References (Be sure to include the address, contact number and your account number):
Steel/Industrial Supply Related Business Trade References (including address, telephone and fax numbers):
I (we) understand that the information furnished you on these pages, hereof, is for the purpose of obtaining credit from your firm. That I am (we are) authorized, in my (our) capacity, to bind my (our) firm accordingly, that all accounts of monies due you shall be due and payable at your place of business. (If agree, print name and title in box provided:)
For accounting information, we should contact:
Click here for Tax Sales/Exemption Certificate
523 Crocket Street, P.O. Box 1152, Channelview, TX 77530-1152
Phone: 281-452-6660 • Fax: 281-452-6464
E-mail:
Sales@EverittPipeValvesFittings.com
