Machinery Rebuilders /

Credit Application

2701 Nicholas Road • Franksville, Wisconsin 53126-9796

(262) 835-9150 • Fax (262) 835-9152 • www.MMRCNC.com Date: December 18, 2007

Complete form in Microsoft Word before printing or fill in manually. Sorry – tab key won’t work as expected. (Use mouse instead.)

In Acceptance and Authorization section, (1) manually check the three check boxes and (2) add your signature.

Fax to 262-835-9152. No cover page necessary.

Need a W-9 from us for your records or to set us up as a vendor? E-mail and we’ll fax one immediately.

Company Information - Physical Address
/ Company Information - Billing Address if different
Company Name
Address
City, State
and ZIP Code
Company Contact Information / Accounts Payable Contact Information if different
Name
Telephone Number and Extension if any / ( ) - ext / ( ) - ext
Fax Number / ( ) - / ( ) -
E-Mail Address
Trade Reference 1 / Trade Reference 2 / Trade Reference 3
Company Name
Billing Address
City, State and
ZIP Code
Contact Name
Telephone Number and Extension if any / ( ) - ext / ( ) - ext / ( ) - ext
Fax Number (Required) / ( ) - / ( ) - / ( ) -
Bank Information
/ Acceptance and Authorization
Bank Name / r / Our payment Terms are Net 30 unless quoted otherwise. By checking this box, you agree to these terms.
Address / r / Our Rates are published on our website and apply unless otherwise quoted. By checking this box you agree to these rates.
City, State and
ZIP Code / r / By checking this box you authorize us to make any and all inquiries necessary to process you application for Credit.
Bank Contact Officer / Authorized Representative
Telephone Number and Extension if any / ( ) - ext / Title /
Fax Number / ( ) - / Signature /
X
Type of Account / Telephone Number and Extension if any / ( ) - ext
Account Number / Fax Number / ( ) -