Volt Credit Application

You may complete this form online and fax or print and complete before faxing.
All mandatory fields are indicated by *


I have included a copy of our resale certificate*
*Your Name:
*Your Email Address:
*Company Name:
*Company Address:
*City:
*State or Province:
*Country:
*Zip or Postal Code:
*Company Phone:
Company Fax:
*Account Payable Contact Name:

Send Monthly Statement Via:	Fax Mail
*DUNS#:
*FED TAX ID:
*Business Entity Type:	Sole Proprietor - Name:
	Partnership - Names of Partners
	- P1
	- P2
	- P3 if applicable
	- P4 if applicable
	Corporation
	- Type
	- Year of Corporation*
		- State, Province, or Country of Incorporation
*Applicant is a(n):	Distributor OEM
Applicant is a(n):	Branch Division Subsidiary Other Related Company

HQ Name:
HQ Address:
HQ City, State, Zip:
HQ Phone:
HQ Fax:
HQ AP Contact:

*(All fields mandatory)
	Business Checking Account
Institution Name:
City, State, Zip:
Phone
Fax:
Contact Name:
Name on Account:
Account Number:
Year Opened:

*(All fields mandatory)
	Credit References
Vendor 1 Name:
City, State, Zip:
Phone:
Fax:
Contact Name:

Vendor 2 Name:
City, State, Zip:
Phone:
Fax:
Contact Name:

Vendor 3 Name:
City, State, Zip:
Phone:
Fax:
Contact Name:

Vendor 4 Name:
City, State, Zip:
Phone:
Fax:
Contact Name:

*Authorized Signature:	________________________________________

*Date: