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Rankin Automation
888 Sussex Blvd.
P.O. Box 190
Broomall, PA 19008
Phone 610-544-6800     Fax 610-328-6594

CREDIT APPLICATION
Firm Name*
Subsidiary or Division of
Address*
City*
State*      Zip*
Telephone*
Fax
Fed Tax ID Number
Are you exempt from Sales tax
If yes, Tax Exempt Number
Please include copy of Tax Exempt Form
Is your company*
Number of years in business
Officers: President
Vice President
Treasurer
Accounts Payable Supervisor*


BANK REFERENCE:
Bank Name*
Account #
Address
City
State      Zip 
Telephone*
Bank Officer*
TRADE REFERENCES:
Company Name*
Address*
City*
State*      Zip*
Telephone*
Fax*
A/P Contact*
 
Company Name
Address
City
State      Zip 
Telephone
Fax
A/P Contact
 
Company Name
Address
City
State      Zip 
Telephone
Fax
A/P Contact
I certify that the above information is correct and that Rankin Automation is authorized
to contact the above noted bank and trade references to evaluate our credit worthiness.
Name* Title*
Date*