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Credit Application

Electro Mechanical Handling, Inc.
P.O. Box 11348
Lynchburg, VA 24506

Phone: 800-289-0989 | Fax 804-239-7825
Email:

Please print and complete the following credit application and fax to:
Electro Mechanical Handling, Inc. at 804-239-7825

Application For Credit
Date:  
Issued To: Electro Mechanical Handling, Inc.
Firm Name:  
  (Name of firm requesting statement)
Phone:  
Address:  
City:   State:   Zip:  
Full Name of Owner(s) (or an authorized officer of corporation). List home address & zip code for partnership or individual.
1.
2.
Please Check One: Individual Partnership Corporation Fed. Tax ID:  

Additional information required for conditional sales contracts under the uniform commercial code.

Debtor Individual Signing Contract:  
Title:  
Debtor's Social Security No:  
  (For Partnership or Individual)
Type Of Business:  
Date Started:  
Estimated Monthly Credit Requirement: $
Former Business:  
Location:  
Own or Rent Building - If Rent, From Whom:  
Real Estate Mortgage:  

Trade References

Please Include Name, Mailing Address, City, State, Zip
1.
2.
3.
Name of Bank:  
Contact:  
Account No:  
Mailing Address:  
City, State, Zip:  

Applicant's signature attests financial responsibility, ability and willingness to pay our invoices in accordance with the following terms: Net 10

Firm Name:  
Signed By:  
Title: