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Thank you for your interest in credit from Shermco Industries. Please provide the requested information below to begin the approval process. All of your information is confidential and this page is secure -- your data will be encrypted before it is transmitted over the Internet.

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2425 East Pioneer Drive
Irving, Texas 75061
972-793-5523/1-888-SHERMCO

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CONTACT INFORMATION
	*Please enter your Shermco contact person's name
COMPANY INFORMATION
	*Company Name
	*Key Contact Person Name
	Key Contact Person Position
	*Street Address
	*City
	*State
	*Zip Code
	Country:
	*Business Phone
	Cell Phone
	*Fax
	*Website Address
	*Email Address
Corp Partnership Individually Owned Other	Type of Business
	*Years in Business
YesNo	*Tax Liable
	Credit Line Requested
	Federal Tax ID #
NoYes *Has applicant ever filed for relief under Bankruptcy or Receivership?
NoYes *Are there any suits or unsatisfied judgments against Applicant?

BANK REFERENCES
	Bank Name
	Address
	Account Number(s) and Type of Account
	Contact Name
Will Send Will Not Send	Financial Statement Available?

	Bank Name
	Address
	Account Number(s) and Type of Account
	Contact Name
Will Send Will Not Send	Financial Statement Available?

TRADE REFERENCES
List three trade suppliers from whom you buy on open account. At least two are required.
	*Company Name
	*Street Address
	*City
	*State:
	*Zip Code
	*Telephone
	*Fax

	*Company Name
	*Street Address
	*City
	*State:
	*Zip Code
	*Telephone
	*Fax

	*Company Name
	*Street Address
	*City
	*State:
	*Zip Code
	*Telephone
	*Fax

The Applicant hereby authorizes all financial institutions, trade or credit references, and whoever may have credit experience to release credit and financial information to Shermco Industries in support of this application and for any subsequent review to grant credit. This application may be reproduced to provide or obtain such authorizations. By completing this form the Applicant hereby agrees to all Terms and Conditions stated or implied. By submitting this form, the Applicant acknowledges and agrees to the above statements and confirms that all information given is true and accurate.
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