Credit Application

Thank you for your interest in Tuffy Manufacturing, Inc. We are in need of the following information, which will enable us to provide your company with the best possible service.

If you want to download this credit application as a Word document, print it and fax to us, click here.

Or you can complete the following form, click submit and we will contact you as soon as possible.

Company Name:  
Shipping Address:  
Billing Address:  
Phone:  
Fax:  
Tax Exempt#:  
D & B#:  
Years in Business:  
Check One:   Partnership    Corporation    Other
Other (if necessary):  
Type of Business:  
Branch Locations:  
Owner(s) Name(s):  
General Manager:  
Retread Shop Manager:  
Service Shop Manager:  
Purchaser/Buyer:  
A/P Manager:  

Please list three principal suppliers.
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Fax:  
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Fax:  
Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Fax:  

Approx. Amount Of Open Credit Desired Per Month  
Bank Name:  
Bank Address:  
Bank Contact:  
Contact Phone Number:  
Name:  
Date: