Credit Application

Thank you for choosing to become an A.V.W. retailer. Please fill out the credit application below and press Submit. We'll process your application immediately. Be sure to fill in all fields to ensure proper processing.

A.V.W. Credit Application
Company Name:
Contact Person:
Email Address:
Physical Address:
City:
State:
Zip Code:
Telephone: (
Fax: (
Website:
Type of Business:
Years In Business:
President/Owner:
Controller:
Accounts Payable:
Purchasing:
Sales Tax #: D&B #: Federal ID #:
Amount of Credit Requested:    $

Bank Information
Name of Bank:
Address:
City: State:   Zip Code:  
Account Number:
Contact Person:
Telephone: (

Please Submit Three Complete Credit References

Company:
Address:
Telephone: ( Contact:
Fax: (



Company:
Address:
Telephone: ( Contact:
Fax: (



Company:
Address:
Telephone: ( Contact:
Fax: (