Moore Manufacturing
71509 Old Cascade Hwy
P.O. Box 309

Skykomish, WA 98288- USA

Credit Application

Name of Company _______________________________________________________________________________

Corporate or legal buying name (if different)___________________________________________________________

Shipping Address Billing Address

Street ________________________________________ Street or Box __________________________________

City ________________________________________ City __________________________________

State ___________________ Zip _____________ State ______________ Zip _____________

Phone (_____)_______-_____________ Phone (_____)_______-_____________

Fax (_____)_______-_____________ Fax (_____)_______-_____________

Check one: Business is a Corporation ____ Partnership ____ Proprietorship ____

How long in business? ________________________________________________

Accounts Payable Person

Name ____________________________________Phone (_____)_______-__________ext________

Email __________________________________________

Bank Reference: Name of Bank __________________________ Branch _____________________

Contact _________________________________ Account Number _______________________________

Address _________________________________________ Phone (_____)_______-_____________

State ____________________ Zip _____________ Fax (_____)_______-_____________

Check here if cash sale is satisfactory until credit is approved (we also take VISA & M.C. cards) _____

Trade References
Name Address Phone Fax

_______________________ __________________________________ (____)____-______ (____)____-______

_______________________ __________________________________ (____)____-______ (____)____-______

_______________________ __________________________________ (____)____-______ (____)____-______

_______________________ __________________________________ (____)____-______ (____)____-______

_______________________ __________________________________ (____)____-______ (____)____-______

Signature _____________________________ Title ___________________ Date ____/____/_______