P.O.

Box 1050, 1401 South Broadway

Red Lodge, MT 59068 USA
800-331-0304 or 406-446-3446
Fax 406-446-1411

CREDIT

website www.crazycreek.com
email chairs@crazycreek.com

APPLICATION

Please fill out completely to qualify for terms.

If you are prepaying with credit card only, please fill out the portion above Bank References and sign the bottom of the form .

Business Name _________________________________________________ DBA or Division ________________________________________

Mailing Address ________________________________________ City, State, Zip ________________________________________________
Shipping Address_______________________________________ City, State, Zip _________________________________________________
Business Phone ____________________________________________ Business Fax _______________________________________________
Buyer/Order Contact ______________________________________ Buyer Phone ______________________________________________
Buyer email________________________________________________ Website ___________________________________________________
Nature of Business (ex. Specialty Sporting Goods) _______________________________________________________________________
Date Opened __________________

Circle One

Corporation

Partnership

Sole Proprietorship

Non-Profit

Fed Tax ID No._________________________________ Amount of Credit Requested ___________________________________________

Name of Owner/Officer_______________________________ Title ____________________________________________________________
A/P Contact _____________________________ A/P Phone __________________________________ A/P Fax _______________________
Bank Reference:
Bank Name___________________________________________________ Phone _________________________________________________
Address ___________________________________________City, State, Zip______________________________________________________
Contact Name ______________________________________________ Account No. ____________________________________________
Dun & Bradstreet No.___________________________________________
Business References: Fax numbers must be up to date as we contact your references by fax. We require 3 favorable
references to assign terms. Listing incomplete or incorrect references may result in prepay terms only.
Name ___________________________________________Address _____________________________________________________________
City, State, Zip__________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address_____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address_____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address_____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Name ___________________________________________ Address_____________________________________________________________
City, State, Zip __________________________________ Fax Number __________________________________________________________
Applicant agrees to financial responsibility, ability and willingness to pay our invoices in accordance with our terms
Credit Net 30 Days/$200 minimum opening order. In the event that a delinquent account is placed in the hands of a
licensed collector or attorney for collection on the account, in addition to the amount of the delinquent account the
applicant shall pay all costs and any reasonable collector's or attorney's fee. A finance charge of 1.5% per month will be
assessed on all unpaid balances.* Initial order must be prepaid before qualifying for terms.
Applicant certifies that the above information is true and correct.
Applicants Authorized Signature _________________________________________________________ Date________________________
Print Name ________________________________________________Title ________________________________________________________