WELCOME TO TAPPAN WIRE & CABLE

Call Us : 1-800-WIRE-911

Fax: 1-845-353-9315

Headquarters:100 Bradley Parkway, Blauvelt, NY 10913

CREDIT APPLICATION /AUTHORIZATION FOR RELEASE
OF CREDIT INFORMATION

APPLICANT’S INFORMATION

Company Name:
Fed Tax ID*
Address
Tele Phone*
Alternate Tele Phone*
Fax*
Contact Name
D&B*

1. TRADE REFERENCE

Company Name:
Acct*
Address
Tele Phone*
Contact Name

2. TRADE REFERENCE

Company Name:
Acct*
Address
Tele Phone*
Contact Name

3. TRADE REFERENCE

Company Name:
Acct*
Address
Tele Phone*
Contact Name

BANK REFERENCE

Bank Name:
Acct*
Address
Tele Phone*
Contact Name

****************************************************************************************************************************************************************************************

AUTHORIZATION RELEASE FOR CREDIT INFORMATION

I authorize and request release of information to Tappan Wire & Cable Inc. for the purpose of establishing credit in an Open Account with this company. I would appreciate your courteous and prompt response to this inquiry.

Company Name
PRINT AUTHORIZED PERSON’S NAME:		DATE:
SIGNATURE OF AUTHORIZED PERSON:		TITLE:

PLEASE NOTE: THIS FORM CAN BE SCANNED & E-MAILED, OR FAXED TO 1-845-353-9315
Written Signature Required:

FOR OFFICE USE ONLY:

ACCOUNT MGR	FIELD REP	TERMS	CREDIT LINE