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CONFIDENTIAL CREDIT APPLICATION

PLEASE COMPLETE ALL PAGES. You may attach your own list of references in lieu of completing page two. TWO Bank References and a minimum of THREE Trade References are required for processing. Information received by Barton Mines is treated with strict confidence and is used only for establishing credit levels for the applicant. Please fax your completed application to 516-612-0094

Company Name:
Phone No:  
Shipping Address:
Fax No:   
City:
State:   Zip Code: 
Email Address:
Billing Address
(If Different):
City:
 State:  Zip Code: 
Type of Business (Please check one):    Corporation:   Partnership:   Individual:
Federal Tax ID:
D&B Number:
Year Started Business: State Incorporated: No. Of Employees
Description of Business (Please check one):    Waterjet:   Blast:   Other:
Anticipated Annual Purchases:      Pounds:     - OR -    Tons:
REQUESTED CREDIT LINE:
Accounts Payable Contact:
Phone No.:
Company Officers:
 President
Vice President
Controller/Treasurer

  Check Here if You Would Like to Receive Invoices via Email: 

 
Valid Email Address to Send Invoices To:   
Sales Tax Exempt    Yes:   If Yes, Exempt #    No:
(Certificate Must Accompany Faxed Applications, Please Mail Original Certificate)

PLEASE NOTE: Barton Mines' Terms of Sale are NET 30 DAYS from Invoice Date. Finance Charges are assessed at the rate of 1-1/2% on payments received late. All outside collection fees are the responsibility of the purchaser.

REMIT TO ADDRESS :      BARTON MINES COMPANY, L.L.C
P.O. BOX 643305
PITTSBURGH, PA 15264-3305

All information above & attached correspondence included with the application is true to the best of my knowledge.

_________________________________ __________ ____________
Authorized Signature
 Title Date
BMD/BMC-REV 11/05

 

 

PLEASE COMPLETE THE FOLLOWING - INCLUDE FAX NUMBER'S

Reference List Attached for Company:

BANK:
Name:
Address:
City:       State: Zip:
Account No: Contact:
Phone No:  Fax No:
BANK:
Name:
Address:
City:       State: Zip:
Account No: Contact:
Phone No:  Fax No:
TRADE:
Name:
Address:
City:       State: Zip:
Account No: Contact:
Phone No:  Fax No:
TRADE:
Name:
Address:
City:       State: Zip:
Account No: Contact:
Phone No:  Fax No:
TRADE:
Name:
Address:
City:       State: Zip:
Account No: Contact:
Phone No:  Fax No:
TRADE:
Name:
Address:
City:       State: Zip:
Account No: Contact:
Phone No:  Fax No:

Barton Mines Company, LLC
Six Warren Street
Glens Falls
NY 12801
Tel: (518) 615-2052
Fax: (516) 612-0094

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