Chicago-Wilcox Manufacturing Company, Inc.

16928 State Street

(708) 339-5000

P.O. Box 126

(800) 323-5282

South Holland, IL 60473

fax (708) 339-9876

 

Credit Application
Please Print or Type:
Business Name
Previous Business Name
Business  Address
Business Mailing Address
City State Zip
Phone Fax
Form of Business Proprietor Partnership Corporation
Type of Business Date Started
Tax Exempt Number Need copy of tax exemption form

Please Provide Three Credit References

Reference #1 Company Name
Address
Phone
Reference #2 Company Name
Address
Phone
Reference #3 Company Name
Address
Phone

 

Name of person responsible for paying invoices:
Title Phone
Name of Chief Purchasing Agent:
Title Phone

If Credit Application is approved, I agree to your terms of Net 30 days.

Authorized signature:
Printed Name:
Title Date Phone