State Supply Company: Credit Application

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Application for Credit

State Supply Co., Inc. offers credit accounts to public institutions and privately held companies that meet our credit extension requirements. State Supply will invoice you immediately following shipment of the product. Terms are net 30 from date of invoice. You may also choose to pay by credit card at any time.

Most public institutions are granted an open line of credit within 2 hours of our receiving this completed form. State Supply Co., Inc. licenses the use of the Dun & Bradstreet credit analysis program to determine the credit worthiness of other companies and corporations. Institutions and companies residing outside of the United State should call State Supply at 651-774-5985. You will be notified via e-mail (or fax if form submitted via fax) with your new State Supply account information. You may then begin purchasing immediately. Once you have completed the form below, please click-on the submit application button.

You can also print out the application form and fax it to State Supply at 651-774-7156. Print the application form by clicking on one of the following icons:

-Microsoft Word format. Download Word Viewer for free.

- Adobe Acrobat format. Download Adobe Reader for free.

Fill out the Credit Application below

Billing Address

Company Name

Address1

Address2

City

State

Zip

Primary Business Phone Number

Building Maintenance Contact:

Building Maintenance
(Purchasing)
Phone Number:

Building Mainenance Email:

(Check if Building Maintenance & Accounts Payable Information are the same)

Accounts Payable Contact:

Accounts Payable Phone Number:

Accounts Payable Email:

(Check if billing & shipping information are the same)

Shipping Address

Company Name

Address 1

Address 2

City

State

Zip

If a private of public commercial business:

Owners/Officers Name:

name 1:

name 2:

Vendor References:

vendor 1 name:

vendor 1 fax number
w/area code:

vendor 2 name:

vendor 2 fax number
w/area code:

vendor 3 name:

vendor 3 fax number
w/area code:

Incorporated?

Yes

if yes....

date incorporated:

bank name:

bank phone number
w/ area code:

PRIVACY STATEMENT

State Supply Co., Inc. does not lease, sell rent or otherwise distribute the names of customers and prospects, within its database, to any other private or public concern. The information provided by the customer or prospect, including all financial information, remains confidentially secured within State Supply Co., Inc. technology systems.

State Supply Co., Inc. does not store credit card number and card name information. Each time a credit card is used the appropriate credit card information must once again be provided for the purchase of product. This protects you from credit card theft by technology hackers and other criminals.

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	-Microsoft Word format. Download Word Viewer for free.
	- Adobe Acrobat format. Download Adobe Reader for free.