Stickley Ace HardwareThe Helpful Place

Business Charge Application

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Nappanee

1524 E. Market St.
(574) 773-7523

Bremen

1245 W Plymouth St
(574) 248-6909

Elkhart

21826 SR 120
(574) 295-5806

Ligonier

1352 Lincolnway S.
(260) 894-3404

LaGrange

110 S Detroit St
(260) 585-8132

Business Charge Application

Application Information

The following information must be provided. It will be held in the strictest confidence.
Address(Required)
Do you require a purchase order?(Required)
Type of Ownership(Required)
Tax Exempt(Required)
Resale(Required)
Ownership(Required)
Name of Officer and Position
Complete Address
Phone
 
Bank Address(Required)
Business References(Required)
Business Name
Complete Address
Phone
Fax
 
List any Comments and/or Names of Persons Authorized to Charge to the Account: (will be treated as Open Account otherwise). Please notify us of any changes to this list.

I/we certify that all the information on this form is correct. I/we fully understand your credit terms and agree to the proper payment in consideration of extended credit. Furthermore, I/we approve of your obtaining information from the above references and a credit report on my company or if not a corporation, a report on me/us personally. If you update, renew, or extend my line of credit, you may request a new report without notice.

MM slash DD slash YYYY
Name(Required)