Batch Management

Engineering

I/Os

Controllers

Human Machine
Interface

Credit Application
 

Please provide all information requested.
Name:
Company:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Web Site:
Business Type: Sole Proprietorship  Partnership  Corporation
Tax-Exempt #:

Personnel

Accounts Payable Contact:
 

Telephone:
 

Fax:
 

Email:

Purchasing Contact:
 

Telephone:
 

Fax:
 

Email:
Bank Reference  
Bank Name:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:
Trade References  
Reference #1  
Company:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:
Reference #2  
Company:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:
Reference #3  
Company:
Address:
Address:
City/State/Zip:
Phone:
Fax:
Email:
Account Number:
Contact:

It does take 2-3 days to acquire all of the information from your
references.  Please make sure that the references are up to date,
INCLUDING FAX NUMBERS, this will shorten the hold time of your order!

 

 
Gross Automation, 1725 South Johnson Road, New Berlin, WI 53146, 262-446-0000, FAX 262-446-0300