Customer/Credit Application -

Customer Information

Company:

Name:

Title:

 

  Our founder, began 30 years ago by buying old garbage trucks

                         and completely rebuilding them                      

   

Street Address:

City:

State:

Zip Code:

Phone Number:

Email Address:

Fax #

ROBERTS HYDRAULICS 

A Division of J L Roberts Industries, Inc. 

(817) 831-0676    (800) 831-0674   Fax: (817) 831-0677    (800) 831-0675

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  Billing Address

  Shipping Address 

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Fax #

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Country:

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Phone Number:

Country:

Fax #

  Trade References (3)  - List Company Name/Address/Contact Name and Phone Number

                         #1:

                            #3:

  Principals - List at least (2) Owners/Officers with Title/Home Address/Phone Number

                     #1:

                            #3:

  Type of Business Structure

Social Security#:

Other Taxpayer #:

  Bank Info

Bank Name:

Bank Address:

Contact Person:

Checking Account #:

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Amount of

Credit You Desire:

Federal ID#:

                  #2:

                  #2:

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Custom Cylinder Specs     Parts Quote   Rebuild/Repair/Service Order

Credit Application    Links Page    Exchange Links

When we set up Credit Terms we will ask for a IRS Form W9 and a Texas Sales/Use Tax Resale or Exemption Certificate that you may fax or mail to us

Link for a online fill-in Texas Sales/Use Tax Resale Certificate:

Link for a online fill-in IRS Form W9:

Link for an online fill-in Texas Sales/Use Tax Exemption Certificate:

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