Credit Application

Company Information

Are you a distributor?(Required)

Yes

Is your company tax exempt?(Required)

Yes

If your company is considered tax exempt please send your tax exempt form(s) to taxexempt@tombstonecity.com. Failure to do so can cause delays in your order processing and/or taxes being added to your invoice(s).

Attach your tax exempt paperwork

Drop files here or

Max. file size: 128 MB.

Please upload any and all documentation that supports your tax exempt status. This includes your state resale or exemption certificate, and if you're exempt in more than one state, a multi-state (uniform) exemption certificate or a separate certificate for each applicable state. Make sure each form is signed, dated, and current. You can upload multiple files or a single combined PDF.

Company Name(Required)

Name of Company Representative completing this form(Required)

First Last

Email of Company Representative completing this form(Required)

Division of (if applicable)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years in Business(Required)

Please enter a number less than or equal to 999.

Years at Current Address(Required)

Please enter a number less than or equal to 999.

Type of Business(Required)

Sole Propreitorship

Corporation

LLC

Name of Owner or President(Required)

First Last

Mobile Phone #(Required)

Email of Owner or President(Required)

Accounts Payable

A/P Contact Person(Required)

First Last

A/P Contact Person Phone #(Required)

A/P Contact Person E-Mail(Required)

Credit References

Please provide FOUR companies that your business has established credit with:

Reference #1

Company Name(Required)

Point of Contact(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #2

Company Name(Required)

Point of Contact(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #3

Company Name(Required)

Point of Contact(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #4

Company Name(Required)

Point of Contact(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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Credit Application

Company Information

Accounts Payable

Credit References

Reference #1

Reference #2

Reference #3

Reference #4

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