Credit Application

Complete this form to start your application

Please provide complete company, banking, and trade reference information. Our team will follow up after review.

Applicant

Your Name *

First Name Last Name

Job Title *

Email *

Phone Number *

Company Information

Company Name *

Company Type *

Tax ID number / EIN *

D&B number

Business Address

Address Line 1 *

Line 2

City * State *

Zip * Country *

In Business Since (year) *

Est. Annual Revenue *

Number of Employees *

Accounts Payable Contact

AP First * AP Last *

Accounts Payable Email *

Accounts Payable Phone *

Tax Exemption / Resale Certificate

Upload certificate

W-9 Form

Upload W-9

Bank Information

Bank Name *

Bank Address Line 1 *

Bank Address Line 2

City * State *

Postal * Country *

Bank Phone *

Trade References

Reference #1 Company Name *

First Last

Reference #2 Company Name

First Last

Reference #3 Company Name

First Last

Account Information

Initial Order Amount in Dollars (If Applicable)

Name of Maddox Sales Representative (If Applicable)

Estimated Annual Transformer Purchases in Dollars *

I Purchase Transformers *

Types of Transformers I Buy *

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended.

E Signature *

First Name Last Name