Credit Application "*" indicates required fields Name of Firm/IndividualFein or S.S.#Business/Home Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*FaxOrganizational Structure Sole Proprietorship Partnership Corporation LLC LLP Type of BusinessHow long in business?In yearsIf individual, name of employer?PositionSole ProprietorSole Proprietor Address / Phone #President/PartnerPresident/Partner Address / Phone #Vice President/PartnerVice President/Partner Address / Phone #SecretarySecretary Address / Phone #TreasurerTreasurer Address / Phone #Bank ReferenceAccount # / Phone #OfficerType of AccountSales Tax Exempt? Yes No If Yes, Enclose a copy of Tax Exempt CertificateAccepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 100 MB.Trade ReferencesName* First Address*Phone*FaxName First AddressPhoneFaxName First AddressPhoneFaxName First AddressPhoneFaxDUNS#Have you ever filed bankruptcy or had judgements against you or your company? Yes No If Yes, please explain.Consent*For the purpose of obtaining merchandise from DREXEL SUPPLY CO. on credit the undersigned make the following statement, We hereby agree to pay all invoices 30 days from invoice date. All past due invoices will be acessed a 1-3/4% service charge per month until paid. In the even that DREXEL SUPPLY CO. must take legal action or the service of a collection agency we agree to pay all reasonable expenses incurred, including attorney fees and court costs. In consideration of DREXEL SUPPLY CO. extending credit to the above applicant after this date at the request of the applicant or its agents, undersigned hereby personally guarantees unconditionally the prompt payment of any sums now and hereafter owed to DREXEL SUPPLY CO. for the supplies or or work performed whether the sums are or will be due under open account, or contract or otherwise. This guarantee shall continue in force until written notice is received by DREXEL SUPPLY CO. stating the date on which the guarantee is to be terminated, said date not to be less than (7) days after the described notice is received. I agree*Officer Signature:*Must be signed by an officerTitleDate*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHA