Credit Application

Phone: 909.629.6655

Fax: 909.629.7355

Credit Application
Accounts Payable Contact:
Your Email Address:

Company Information

Company Name:
Company Address:

City:

State:

Zip:

Telephone:

Fax:

Type of Business:
Years in Business:

Partners or Corporation Officers

Name	Title	Telephone

Bank References

Bank Name & Address	Account Number (s)	Contact Name & Phone

Trade References
(must include fax numbers)

1.	Ph:	fax:
2.	Ph:	fax:
3.	Ph:	fax:
4.	Ph:	fax:
5.	Ph:	fax:

I agree to pay all invoices on time or pay 1.5% per month service charge on past due amounts, and pay legal costs and attorney fees if collection of account is necessary. I authorize Pomona Precision Grinding to contact any or all of the above listed banks and trade references for credit verification purposes.

I certify that the above information is true. This information is to be used only for opening an account.

* Indicates required fields.