CREDIT APPLICATION
Fax to (757)440-6705, Attn: Dottie Black
   
Company Name:
Address:
City: State: Zip:
   
Attention:
E-Mail:
Phone: Fax:
   
  Corporate/Parent Address:
   
  Nature of Business:
   
  Federal Tax ID#: Years in Business:
   
  General Manager:
   
  Accounts Payable Contact:
   
Bank Name: Phone:
Branch Address:
City: State: Zip:
   
Credit References  
 
Name: Phone:
Address:
City: State: Zip:
   
Name: Phone:
Address:
City: State: Zip:
   
Name: Phone:
Address:
City: State: Zip:
   
OUR TERMS ARE NET, 30 DAYS

Past due invoices are subject to a 1.5% monthly service charge.

Click the button below to create a printable
version of the completed application. Print
the resulting form, and fax to (757)440-7000 or
mail to P.O. Box 1387, Norfolk, VA 23501-1387