Credit Application

Please send your completed form electronically by clicking the "Submit" button at the bottom of the form, or print the form and fax to Selco Products:(714) 917-1355.

*Required Fields

General Information

Company Name*

Contact Name*

Address*

City*

State*

Zip+4*

Phone*

Fax

Business License #*

In Business Since*

E-mail*

Do you

Lease Rent Own

Building Sq Footage

Annual Sales Volume

California or New York Resale #*

Corporation (complete below)

Federal Tax ID #

President

Chief Financial Officer or Controller

Parent Company

Address

City

Zip+4

Phone

Fax

Sole Proprietor & Partnership (complete below)

1. Name

SS#

D/L

Address

City

State

Zip+4

2. Name

SS#

D/L

Address

City

State

Zip+4

Trade References (please furnish complete information including fax #'s)

1. Firm Name

Address

City

State

Zip+4

Phone

Fax

2. Firm Name

Address

City

State

Zip+4

Phone

Fax

3. Firm Name

Address

City

State

Zip+4

Phone

Fax

Banking Information

Bank

Address

Ckg A/C#

Bank

Address

Svg A/C#

We will contact you as soon as your credit information has been processed. Thank you.

Selco Products Co.
605 South East Street
Anaheim, CA 92805
714•917•1333 Tel
714•917•1355 Fax
Toll-Free Phone:
800-257-3526