Heckmann Building Products Inc.
1501 N. 31st Avenue - Melrose Park, IL 60160-2911
800-621-4140 FAX: 708-865-2640
APPLICATION FOR CREDIT - Print out and Fax Back
NAME OF COMPANY _______________________________________
ADDRESS ________________________________________________
CITY, STATE, ZIP __________________________________________
PHONE: ____________________ YEARS IN BUSINESS: __________
The company or Individual listed above hereby applies for credit in accordance with the terms and conditions of Heckmann Bldg Products. Normal Credit terms are Net 30 days.
Ownership: ____ Corporation ____ Individual ____ Partnership
Principal Officers: _______________________________________________
______________________________________________________________
______________________________________________________________
Financial Information: Bank Phone No. _____________________________
Bank Name: ____________________________________________________
Bank City, State, Zip: ____________________________________________
Trade References:
1: Name: ___________________________ Phone: ____________________
2: Name: ___________________________ Phone: ____________________
3: Name: ___________________________ Phone: ____________________
We the undersigned certify that all the information that we have stated on this form is correct. We fully understand the credit terms of Heckmann Building Products and we agree to the proper payment in consideration of credit extended to thirty days from the invoice date.
SIGNED: ________________________________________
TITLE: __________________________________________
DATE: _______________________________
Fax Back to: 708-865-2640
© Copyright 1999 Heckmann Building Products Inc.