Credit Application

Please complete ALL information to allow for timely processing. If your application is approved, it is your responsibility to keep us informed of any information that may change (IE: address, phone #, etc.). Should Attaway, Inc. incur any charges due to incorrect information these will be passed along to the customer

Customer Name
First Last
Billing Address
Street Address City State ZIP Code
Shipping Address
Street Address City State ZIP Code
Phone
Fax
Purchasing Agent
Email
A/P Contact
Email
If Tax Exempt, please attach appropriate form.
Bank Name
Bank Address
Street Address City State ZIP Code
Trade References
Name
First Last
Address
Street Address City State ZIP Code
Email
Fax
Name
First Last
Address
Street Address City State ZIP Code
Email
Fax
Name
First Last
Address
Street Address City State ZIP Code
Email
Fax
Consent
I agree to the privacy policy.
The above information is for the purpose of obtaining credit from Attaway, Inc. and is warranted to be true. I authorize you to investigate the above references and to obtain credit information from them. I agree to the terms and conditions of the sale. Should a line of credit be granted by Attaway, Inc. all decisions with respect to the extension or continuation shall be in the sole discretion of Attaway. Attaway, Inc. may terminate my credit availability at any time.
Authorized Signature
Title
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Trade References