Credit Application

Date:
Your Name:
Title:
Company Name:
Mailing Address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Telephone No.:
Fax No.:
Email Address:
Is Company Taxable? Yes No If NO, Please send a signed copy of resale certificate to us by fax: (713) 468-6528 or email info@fuseplus.com
Principal Officers:
1) Name:
1) Title:
2) Name:
2) Title:
Bank References:
Name of Bank:
Acct No.:
Phone No.:
Officer:
Trade References:
1) Company:
Address:
Phone No.:
Fax No.:
2) Company:
Address:
Phone No.:
Fax No.:
3) Company:
Address:
Phone No.:
Fax No.:

FusePlus - 1-800-388-FUSE
1780 W. Sam Houston Parkway N. Houston, Texas 77043
(713) 468-7984 OR | Fax: (713) 468-6528 | info@fuseplus.com | Monday through Friday 8am to 5 pm

Visa Mastercard Discover
Visa, MasterCard and Discover accepted