Credit Application

For your convenience WB Bottle Supply accepts MasterCard, Visa and American Express. To allow your company additional purchasing power and to facilitate future orders, you may complete our on-line credit application so a corporate line of credit can be established for your company.

Note: Please complete all fields for expedited processing.
THIS CREDIT APPLICATION IS BEING SUBMITTED BY:
Legal Name:
Other Names Used:
Address:
City:
State:
Zip:
Phone:
Fax:
Years in Business:
Type of Business:Corporation: Partnership Proprietorship
Website Address:
eMail Address of Purchasing Contact:
NAMES OF PRINCIPAL OFFICERS, PARTNERS, OR OWNERS
Name:
Title:
Name:
Title:
PERSON TO CONTACT REGARDING FINANCIAL MATTERS:
Name:
Title:
HAVE WE EVER SOLD TO YOU BEFORE OR TO ANY PRESENT OR FORMER AFFILIATE?
No:
Yes:
TRADE REFERENCES
Name:
Phone & Fax:
Address:
Name:
Phone & Fax:
Address:
Name:
Phone & Fax:
Address:
BANK REFERENCES
Bank:
Phone & Fax:
Address:
Loan Officer:
WE ESTIMATE OUR ANNUAL PURCHASES AT:
Dollar Amount$:
and we request a credit line of:

WISCONSIN AND ILLINOIS CUSTOMERS: PLEASE SUBMIT A SALES TAX EXEMPTION CERTIFICATE VIA FAX OR MAIL AT YOUR EARLIEST CONVENIENCE.
We are required to charge sales tax unless we receive an exemption certificate

To WISCONSIN AND ILLINOIS CUSTOMERS: PLEASE CLICK HERE TO DOWNLOAD A SALES TAX EXEMPTION CERTIFICATE AND RETURN AT YOUR EARLIEST CONVENIENCE. We are required to charge sales tax unless we receive an exemption certificate

Wisconsin Sales Tax Exemption Form | Illinois Sales Tax Exemption Form

Check here if cash sales are OK until credit is approved

By submitting this applicaiton, the applicant states that the information provided is for the purpose of obtaining credit references and is represented by the applicant to be true and complete. The applicant authorizes us to investigate all credit references and any other matters pertaining to its financial responsibilitu. The undersigned authorizes its bank(s) and trade creditors to submit complete information for the purpose of credit evaulation. The undersigned fully understands the credit terms of W.B. Bottle Supply Co., Inc. and agrees to pay before the due date according to the terms of sale stated on each invoice.
Company
Date
Your Name
Title