<%@LANGUAGE="VBSCRIPT" CODEPAGE="65001"%> <% Option Explicit %> Bedford: Credit Application
Credit Application
Bedford Industries, Inc. accepts payment for orders in a variety of ways. We accept credit cards including, American Express, MasterCard, and VISA. We also accept Cash on Delivery (COD), Cash in Advance, or you may wish to establish a business line of credit.

Fill out the credit appliction below and click on the "Submit" button. To download a PDF file click the "Credit Application" button. You will need to have Adobe Acrobat on your PC to view this document. After you have printed the form, please complete the informatin fields, and return it to us. Be sure to sign the form and return by faxing to: 1-507-376-6742.
Our Credit Manager will contact you if your application requires further action. Otherwise, your Account Representative will be notified of your approval, and you will be contacted regarding an order. Please call any time if you have a question regarding the credit application.

**Note: Should you proceed in establishing a line of credit with Bedford Industries, Inc., please be advised that information you supply on our credit application may be shared with affiliated credit companies (Dun & Bradstreet and TRW).

Credit Application
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Customer Information Form
<% response.Write(cstr(strErrorMessage)) %>

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCustomerName) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormBillToAddress) %>" />
class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPhoneInfo) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormShipToAddress) %>" />
   
Customer Background
class="errorInField" <% end if %>> Type of Business (check one)
   0 then %> checked="checked" <% end if %>/>      0 then %> checked="checked" <% end if %>/>      0 then %> checked="checked" <% end if %>/> 		class="errorInField" <% end if %>> Line of Business (check one)
  0 then %> checked="checked" <% end if %>/>   0 then %> checked="checked" <% end if %>/>   0 then %> checked="checked" <% end if %>/>   0 then %> checked="checked" <% end if %>/>
   

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormDateBusinessEst) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormDunBradstreet) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormStateTaxExemp) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormOwnerPresident) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormResidenceAdd) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCityStateZipBkgd) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPhoneBkgd) %>" />
class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormSocialSecurity) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormProductSold) %>" />

class="errorInField" <% end if %> size="50" maxlength="00" value="<% Response.Write(strFormNAICS) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormAccountsPayableMgr) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPurchasingAgent) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormNormalOrderSize) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormEstAnnualSales) %>" />
   
Trade and Bank Credit References

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCompanyNameA) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormAddressA) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCityStateZipA) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPhoneA) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormFaxA) %>" />
class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCompanyNameB) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormAddressB) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCityStateZipB) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPhoneB) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormFaxB) %>" />
   

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCompanyNameC) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormAddressC) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCityStateZipC) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPhoneC) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormFaxC) %>" />
class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormBankBranchD) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormAddressD) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormCityStateZipD) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormPhoneD) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormFaxD) %>" />
   
Applicant's signature/name attests financial responsibility, ability and willingness to pay our invoices in accordance to the terms they have been given.

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormSignatureName) %>" />

class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormTitle) %>" />
class="errorInField" <% end if %> size="50" maxlength="60" value="<% Response.Write(strFormDate) %>" />