Credit Application - Go Salt

Credit Application

Company name & address (Please provide a street address, not a P.O. Box number)

Company *

Address *

Owner(s) or Officer(s) – Please include title:

Sales Tax Info:
Tax will be applied to all orders unless tax and/ or resale certificate is provided. If you are exempt from sales tax or have a resale certificate, you must provide your exemption and/or a resale certificate with your completed credit application
TaxableExemptResale

Reference 1

Company *

Name *

Phone *

Email *

Reference 2

Company *

Name *

Phone *

Email *

Bank Reference

State *

City *

Account Number *

Phone *

Signature *

Date *

Upload Your W9 *