CREDIT APPLICATION 

If you would like to deal with us on a credit basis, please fill in the information below. Do not press ENTER; this will submit your form prematurely.  Complete as many details as necessary; required fields are in red.  You can leave boxes blank if you wish, but we do need your basic information plus three supplier references. There is a free-form comments section at the bottom. When complete and correct, click on the SUBMIT FORM button at the bottom. Your information will not be used for any purpose other than to respond to your credit request.

E-business:  Quotation Request   Credit reference   Place order

Other response forms:  Feedback form   Batching application questionnaire   RadarTron application questionnaire   Siloweigh questionnaire   Dealer application   

Name	Title
Company	E-mail
Phone/ext.	Fax
Street address	Employment Insurance Number (U.S. customers only)
Type of business End user dealer/O.E.M.	Business status Corporation Partnership Individual
Bank name	Account #
Bank address	Bank phone Fax   Email
SUPPLIER REFERENCES (MINIMUM 3 REQUIRED)
Company 1 City/State	Phone Fax E-mail
Company 2 City/State	Phone Fax E-mail
Company 3 City/State	Phone Fax E-mail
Company 4 City/State	Phone Fax E-mail
TEXT AREA - Add your comments or message in box at right:
Credit amount requested	(with type of currency if not US or CAD $ )
Real people, enter the numbers you see at right