Credit App -

Draffens Industrial Supply Credit Application Form

Qualified customers are encouraged to establish an account with Draffen's Industrial Supply. You can fill in the form below to request a credit account or you can download the form by clicking here. All downloaded applications must be emailed to valerie.draffens@gmail.com. All applications must fully completed.

Name of business: *

Shipping address: *

Billing Address *

Telephone *

Fax

Email *

Accounts payable contact *

Accounts payable contact number

Do you require a purchase order number or other information? *

Do you pay sales tax on your purchases? *

(Please note - if you do not pay sales tax - we must have a copy of your exemption certificate)

Federal ID Number *

Nature of business *

How long in business? *

Type of business

Customer copy of invoice is given at the time of sale or delivery, if you don't need a copy we can either:

Name of owner, partners or corporation officers (including titles) *

Banking Information

Bank Name *

Account Number *

Bank Address *

Bank Phone Number

Bank Contact *

Trade References (Please list 3 current trade references)

Reference 1

Reference 1 Name *

Reference 1 Address *

Reference 1 Telephone Number *

Reference 1 Fax

Reference 1 Account Number *

Reference 1 Contact *

Reference 2

Reference 2 Name *

Reference 2 Address *

Reference 2 Telephone Number *

Reference 2 Fax

Reference 2 Account Number *

Reference 2 Contact *

Reference 3

Reference 3 Name *

Reference 3 Address *

Reference 3 Telephone Number *

Reference 2 Fax

Reference 3 Account Number *

Reference 3 Contact *

OUR TERMS ARE NET 15 DAYS FROM INVOICE DATE WE GIVE PERMISSION TO THE ABOVE-LISTED REFERENCES TO RELEASE CREDIT INFORMATION TO DRAFFEN’S INC FOR THE PURPOSE OF OPENING AN ACCOUNT.

Date: *

Authorized Signature and Title *

Please upload a proof if ID and Copy of your sales tax exemption certificate (if applicable) *

Draffens Industrial Supply Credit Application Form

(Please note - if you do not pay sales tax - we must have a copy of your exemption certificate)

Banking Information

Trade References (Please list 3 current trade references)

Reference 1

Reference 2

Reference 3

OUR TERMS ARE NET 15 DAYS FROM INVOICE DATE WE GIVE PERMISSION TO THE ABOVE-LISTED REFERENCES TO RELEASE CREDIT INFORMATION TO DRAFFEN’S INC FOR THE PURPOSE OF OPENING AN ACCOUNT.

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Draffens Industrial Supply Credit Application Form

(Please note - if you do not pay sales tax - we must have a copy of your exemption certificate)

Banking Information

Trade References (Please list 3 current trade references)

Reference 1

Reference 2

Reference 3

** OUR TERMS ARE NET 15 DAYS FROM INVOICE DATE ** WE GIVE PERMISSION TO THE ABOVE-LISTED REFERENCES TO RELEASE CREDIT INFORMATION TO DRAFFEN’S INC FOR THE PURPOSE OF OPENING AN ACCOUNT.

Cookies Policies

OUR TERMS ARE NET 15 DAYS FROM INVOICE DATE WE GIVE PERMISSION TO THE ABOVE-LISTED REFERENCES TO RELEASE CREDIT INFORMATION TO DRAFFEN’S INC FOR THE PURPOSE OF OPENING AN ACCOUNT.