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Credit Application

Thank you for choosing to become an A.V.W. retailer. Please fill out the credit application below and press Submit. We'll process your application immediately. Be sure to fill in all fields to ensure proper processing.

A.V.W. Credit Application
Company Name:
Contact Person:
Email Address:
Physical Address:
City:
State:
Zip:
Telephone: ( )
Fax: ( )
Web Site:
Type of Business:
Corporation Partnership Sole Proprietorship
Years in Business:
President/Owner:
Controller:
Accounts Payable:
Purchasing:
Sales Tax #: D&B #: Federal ID #:
Amount of Credit Requested: $

Bank Information
Name of Bank:
Address:
City: State: Zip:
Account Number:
Contact Person:
Telephone:

Please Submit Three Complete Credit References
1.
Company:
Address:
Telephone:( ) Contact:
Fax:( )




2.
Company:
Address:
Telephone:( ) Contact:
Fax:( )




3.
Company:
Address:
Telephone:( ) Contact:
Fax:( )