Credit Information for Church or Other Organization
(Required fields are bold.)

Correct Billing Name:
Mailing Address:
City, State, Zip:    
   
Person in Charge of Paying Account:
Mailing Address:
City, State, Zip:    
   
Phone Number:
   
Names and Addresses of Officer(s):  
 

Address:  

   
 

Address:  

   
 

Address:  

   
   
Bank(s)  
   
Credit References:  
 

Address:  

   
 

Address:  

   
 

Address:  

   
 

Address:  

   
   
Amount of Credit Desired: $

 

TERMS: Net 30 Days.  Prior arrangements are needed if there is any variation in payment.  Please notify of any changes in mailing address that occur.

Upon clicking the Finalize Application button below, a new window will open with your completed application.  Please print this application and sign and date it.  Then, mail or fax your application to:

Hardman Supply Company
Attn. Credit Department
102 Court Street
Spencer, WV  25276
Fax: 304.927.4702