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Credit Application
Please fill out this application and hit the "Submit" button at the bottom of the page. The information you input will be emailed
to our accounting department. You may also print this form out and fax it to: 706-864-0691.
Date:
Your Name:
Your Title:
Your Email:  
Name of Business:
Legal Name:
Street Address-Include Street/City/State/Zip:
Mailing Address (if different from above)-Include Street/City/State/Zip:
Accounts Payable Contact:
Phone: Fax: Email:  
Year Business was Estalished :
TRADE REFERENCES * Must have at least 3 references in order to be processed.

1. Name

2. Address

3. Phone

4. Fax

5. Years Doing Business

6. High Balance

1. Name

2. Address

3. Phone

4. Fax

5. Years Doing Business

6. High Balance

1. Name

2. Address

3. Phone

4. Fax

5. Years Doing Business

6. High Balance

1. Name

2. Address

3. Phone

4. Fax

5. Years Doing Business

6. High Balance

Tax Exempt? If Yes, please enter your Tax Exempt I.D.#:

Do Your Orders Need to Automatically Come with a Purchase Order?
List of Persons Authorized to place orders:
Additional comments or questions
   

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RefrigiWear, Inc. | 800-645-3744 | 54 Breakstone Drive, Dahlonega, GA 30533
©2008 Refrigiwear, Inc.