FH Customer Credit Application

FH Credit Application

Company Information
Company Name*
Credit Limit Requested*
Date*
MM slash DD slash YYYY
Tax ID (FEIN #)*
Exempt Status*
Sales Tax Exemption #
Upload Tax Exempt Certificate
Drop files here or

Accepted file types: pdf, jpg, gif, png, tif, docx, Max. file size: 10 MB, Max. files: 3.
Address Information
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Shipping Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Info
Accounts Payable Contact Name*

(First & Last Name)
Accounts Payable Contact Phone*
Accounts Payable Email*
Email for Invoices*
Email for Statements
Business Info
Business Type*
Date Company Started*
MM slash DD slash YYYY
Company Classification*
List Owners/Principals:
1. First & Last Name*
Title*
2. First & Last Name
Title
3. First & Last Name
Title
Trade References:
1. Company Name
Contact Name
Email
2. Company Name
Contact Name
Email
3. Company Name
Contact Name
Email
Customer Portal:

Faulkner Haynes maintains an online Customer Portal that allows customers to track orders & shipments, as well as view/download invoices & statements. Please list anyone (not already listed above) who should have a login for the Customer Portal
1. Name
Email
Title
2. Name
Email
Title
3. Name
Email
Title
Name of Faulkner Haynes Employee You’ve Been Working With*
Attach File(s) here:
Drop files here or

Max. file size: 16 MB.
Signature/Consent:
Name of Person Completing Application*
Title*
E-mail*
Consent*
- I agree to the following terms:
By submitting this application, I agree to allow Faulkner Haynes to use the information provided for the purposes of determining whether to offer business credit to the company listed herein. Submission of this application does not guarantee credit approval. Additionally, I represent that I am authorized by the company listed herein to submit this application on its behalf.
Email
This field is for validation purposes and should be left unchanged.

FH Credit Application

Company Information

Address Information

Billing Info

Business Info