Customer Credit Application

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Howard Industries, Inc. | Customer Credit Application

Note: ASCII Members that have already filled out a credit application may opt to Fax a copy of that credit application to Micah Stevens at: (601).399.5060 instead of completing the online application. If you would like ASCII to fax a copy of your credit application or have any problems please contact Joyce Doherty at jdoherty@ascii.com.
Date: 12/19/2018
COMPANY INFORMATION * Indicates required field
* Name of Business:
* Physical Location:
* City / State / Zip:  /   / 
* Mailing Address:
* City / State / Zip:  /   / 
* Type of Business: PROPRIETORSHIP        CORPORATION        PARTNERSHIP  
* Date of Incorporation:
* Federal ID: * Sales Tax Status:
* President / Partner:
* Vice President / Partner:
* Other / Partners:
* Annual Sales: $
BANKING INFORMATION * Indicates required field
* Name of Bank: * Contact:
* Account No: * Phone No:
* Type of Account: * Fax No:
TRADE REFERENCES * Indicates required field
( Please provide references whose volume or type of transactions you will do with our company. )
1 Name: Contact:
Address: Phone No:
City/State/Zip: / / Fax NO:
2 Name: Contact:
Address: Phone No:
City/State/Zip: / / Fax NO:
3 Name: Contact:
Address: Phone No:
City/State/Zip: / / Fax NO:
4 Name: Contact:
Address: Phone No:
City/State/Zip: / / Fax NO:
5 Name: Contact:
Address: Phone No:
City/State/Zip: / / Fax NO:
COMPLETED BY: * Indicates required field
  * Name: * Email:
  * Title: * Phone:
* Please fax the most recent audited financial statement available and a letter to bank authorizing release of information to the number provided below.
Fax:  1.601.399.5077
* If you are a reseller, we must have your Resale Certificate or Tax Exemption Certificate on file. If purchases by your company are for your own use and you want to be responsible for paying sales tax direct to the state then we must have a copy of your Direct Pay Permit on file.
All information is considered Confidential.

 
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