Application for Credit

Complete this form to apply for a credit line and wholesale purchasing account with ILLCO.

1. Company & Contact Information

Company Name *

Billing Address *

City *

State *

ZIP Code *

Billing address same as shipping address?

Phone *

Fax

Email Address (Invoicing & Payables) *

Purchasing Contact

Payables Contact

2. Business Structure & Financials

Type of Business / Contractor *

Business Entity *

Incorporation Date

State of Inc.

Time in Business

Amount of Credit Requested ($) *

Name of Officers, Partners, or Individuals *

3. Account & Purchasing Preferences

Name of Salesperson Worked With at ILLCO

Require P.O. Numbers? *

Require Job Numbers? *

Subject to State Sales Tax? *

4. Bank Reference

Bank Name

Bank Contact Name

Bank Address

City

State

ZIP Code

Bank Phone

Bank Fax

Bank Email

Checking Account #

Loan Account #

Other Account #

5. Trade References (3 Required)

Trade Reference #1

Company Name *

Account Number

Address

City

State

ZIP

Telephone *

Contact Name

Trade Reference #2

Company Name *

Account Number

Address

City

State

ZIP

Telephone *

Contact Name

Trade Reference #3

Company Name *

Account Number

Address

City

State

ZIP

Telephone *

Contact Name

6. Terms Agreement & Digital Signature

By submitting this application, you agree to the ILLCO credit terms. Standard payment terms apply. Past-due balances are subject to finance charges.

I agree to the terms of service. *

Digital Signature (Type Full Legal Name) *