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Indianapolis ParkerStore Open House

August 14, 2019 @ 11:00 am - 2:00 pm

We are excited to announce the opening of our 11th branch. Exotic Automation & Supply is coming to Indianapolis! Please join us in celebrating with an open house.

We hope you will be able to attend! Please RSVP below… See you there!

Credit Application

application

REQUIRED

Legal Name(Required)

Trade Name(Required)

Credit Amount Requested(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Employees(Required)

Phone(Required)

Fax(Required)

Dun & Bradstreet Number(Required)

Year Business Started(Required)

Annual Sales Volume(Required)

Dun & Bradstreet Number(Required)

President / Owner(Required)

First Last

AP Contact(Required)

First Last

AP Email(Required)

AP Phone(Required)

Email or Fax Invoices to(Required)

Purchase Orders Required?

Yes

Freight Collect Account(Required)

Doing Business As

Corporation

Partnership

Sole Proprietorship

LLC

BANK REFERENCE

Complete or Attach

Bank(Required)

Phone

Fax

Contact(Required)

First Last

Checking Account #(Required)

Savings Account #(Required)

CREDIT REFERENCE

List only credit references that have given you an open line of credit

(1) Name(Required)

Account #(Required)

Phone(Required)

Fax(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

(2) Name(Required)

Account #(Required)

Phone(Required)

Fax(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

(3) Name(Required)

Account #(Required)

Phone(Required)

Fax(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name(Required)

First Last Title

Date(Required)

Please attach any additional documents below.(Required)

Drop files here or

Max. file size: 100 MB.

Tax Forms, Credit References, etc.

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Details

Date:: August 14, 2019
Time:: 11:00 am - 2:00 pm