SnuggleHose  -  Credit Application (Term 30 Days Net)
To apply for credit, please print and fill out the following credit application. Mail or fax your form to the address at the bottom of the page. Unfortunately, we do not accept applications over the web at this time. Fields in red are required for wholesale pricing. Items in black are required only if you are applying for credit. If you choose to pay by credit card, make sure to fill in the credit card information.

Applicant Information
Legal Name of Company:
Jurisdiction of Applicant's Formation (e.g. Utah):

Address of Chief Executive Officer
Name:
Street:
City:
State:           Zip:

Contact Person
Name:
Phone:
Fax:

Billing Address
Street:
City:
State:           Zip:

Shipping Address
Street:
City:
State:           Zip:

  
Company Information
Years in Business:
EIN Number:
City:
State:           Zip:

Tax Exempt Status
Tax Exempt or Tax Resale Number:
Is Business Sales-Tax Exempt?   yes   no

Applicant Owner Information
Name of Principle:
Social Security Number:
Percent of Ownership:

Trade Reference
Company:
Phone:
Account Number:

Credit Card Payment
Name on Card:
Number:
Exp:
Card Type (circle one): VISA, Mastercard, Discover
Signature
Applicant hereby authorizes SnuggleHose Co. to consider providing financing to Applicant pursuant to this Credit Application, to contact any or all of the above references, or use any public or private information available to make a valid credit appraisal of applicant. The individual executing this Credit Application, who is a principal of the Applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by SnuggleHose Co. from time to time as may be needed, in the credit evaluation process. Applicant and the undersigned principal understand and consent to the terms and conditions of this credit policy.
Signature: Date:


SnuggleHose, LLC
459 E. 1300 S.
Salt Lake City, UT 84115
Phone: (801) 710-1159
Fax: (801) 731-1735