Online Credit Application

Online Credit Application Form

Fallsway Account Manager

Company name*

DBA (if different)

Accounts Payable Contact*

Accounts Payable Email*

Contact Name*

Email*

Phone Number

Fax number

Street address*

City*

State/Region*

Postal code*

Ship To Address ((If Different))

Federal Tax ID*

Are you Tax Exempt?*

Tax Exempt Form (If applicable)

Type of Business*

Date Business was Established*

Amount of Credit Requested*

Bank Account #

Credit References*Please include the company names and contact info for 3 references. If you have a credit reference sheet, please attach below and type "See attached" in this field

Credit References Sheet

Names, Titles, & Addresses of Owner, Partners, or at least 2 Principals*

Business Structure*

Purchase Order Required?*

Have you had credit with us previously?*

Authorized Purchasers*

Terms: Net 30 days to credit approved accounts only. A fee of $45.00 will be charged for all returned checks. Past due accounts are subject to credit review and will be charged 2% per month interest (24% apr). Collection and/or attorney fees will be added in the event of forced collection.

I agree to the above terms and conditions and agree to pay any and all service, collection and legal fees incurred.

Printed Name*

Title

Date*

Please contact AR@fallsway.com with any questions regarding the credit application process.

Credit Application

Online Credit Application Form

Akron Headquarters:

Youngstown Branch: