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Website designed by		Online Credit Application Please fill out this form completely. All fields are required, except where indicated. Select your location Phoenix Las Vegas Anaheim Bakersfield Boise Company information Company name: Phone: -- Fax (optional): -- Partnership Sole Owner Non-Profit Corporation If business is a corporation (required only if applicable): State of Articles of incorporation No. Date Federal ID #: State Tax #: Address information Please indicate actual address, not P.O. box numbers Billing address: City: State: ZIP: How long? Delivery address: City: State: ZIP: How long? Business information Type of business: P.O.s required? Yes No Bank information Account #: Bank name: Account type: Phone: -- Trade references Please provide three trade references. Name: Address: City: State: ZIP: Phone: -- Fax: -- Name: Address: City: State: ZIP: Phone: -- Fax: -- Name: Address: City: State: ZIP: Phone: -- Fax: -- I authorize Alternative Hose Inc. to investigate any bank or trade references listed above. In consideration of extensive credit by Alternative Hose Inc. to the applicant at any time from time to time hereafter, applicant agrees to pay for each purchase according to terms of purchase in effect at the time of each purchase as shown on its invoices, statements and quotations. Applicant further agrees to pay actual costs of collection including actual attorney's fees whether or not litigation is commenced or prosecuted to final judgment of any obligation arising hereafter to Alternative Hose Inc. in addition to the amount of the obligation. Name: Title: E-mail address: Date: Clicking the button below serves as your signature. Home • About us • Mobile service • Quote request • Credit application • Job application Alternative Hose, Inc.: Phoenix • Las Vegas • Anaheim • Bakersfield • Boise • Atlanta