ActionPak Credit Application

Credit Application

Please complete the following:

Company Name: _____________________________________________________

Mailing Address: _____________________________________________________

Physical Address: ____________________________________________________

Years in Business: ___________

Date of Incorporation: ___________ State: ___________ TIN: __________________

Below please list the name and fax number of 3 companies you have an account with:

Company: ____________________________ Acct #: ________________________

Fax #: _______________________________

Company: ____________________________ Acct #: ________________________

Fax #: _______________________________

Company: ____________________________ Acct #: ________________________

Fax #: _______________________________

If you are tax exempt please enclose a completed sales tax exemption certificate.

Mail form to:	Fax to:
ActionPak Inc. Keystone Industrial Park PO Box 557 Bristol, PA 19007	(215) 788-1760