Mephisto Tool
Credit Application

To use this form, make a print and fill in the information. It may be sent by Fax or Mail. If you prefer, scan the sheet and send it by E-mail attachment. Also, you may write out your own Paper or E-mail message, with the requested information. Or just pick up the phone and talk to us.

Fax: 518-828-2711
Phone: 518-828-1563
E-mail: credit@MephistoTool.com		 U.S. Mail:
Mephisto Tool Co., Inc.
PO Box 16
Hudson, NY 12534-0016

If applicable, please include your Tax Exempt Resale Certificate with this page. It only needs to be sent once.
Date:
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Company Name:
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Address:
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Telephone Number:
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FAX Number:
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E-mail:
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References
Bank Name:
 ___________________________________________________________
Contact Name:
 ___________________________________________________________
Telephone Number:
 ___________________________________________________________
Suppliers:
(please list at least 3 major suppliers)
Name and Address
Telephone Number
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_____________________________________________________________
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Signed:
 ___________________________________________________________
Title:
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