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Credit Application Form

Please fill-out every section in the form. Forms missing data will not be processed.

(*Required Fields)

*Company Name:
*Contact Name:
*Telephone No.:
*Fax No.:
*Email Address:
*Business Type: (Individual, Partnership, Corporation)
*Owners or Principal Name:
*Purchase Order Required: (Yes or No)
Tax Exempt: (Yes or No. If Yes, please enter number)
*Credit Information No.1: (Name and Phone number)
*Credit Information No.2: (Name and Phone number)
*Credit Information No.3: (Name and Phone number)
*Bank Information: (Name, Phone, & Account number)
*Signature: (Enter name of person applying)

I authorize CTT Industrial to check my credit history with the above listed references to process this application. I also agree to their terms, which is net 30 days from invoice date.

Website? If Yes, please enter your Web address
Comments or Questions:

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