Snow Guard Credit Application

Credit Application

To apply for credit with IceBlox, Inc. d.b.a. SnoBlox-SnoJax please complete the form accurately and completely. First time purchases must be paid for with a credit card or a check in advance. Upon credit approval, you will be faxed an order confirmation form to be signed and returned to

Fax 1-717-697-6141 or Toll Free Fax 1-800-634-7906
Incomplete forms will not be processed. All Fields are Required:

Company Details
Company Name:
D.B.A:
Billing Address:
Address 2:
City:
State:	Zip:
Telephone:
Fax:
Email:

Shipping Details: Check if same as Billing Address.
Company Name:
Shipping Address:
Address 2:
City:
State:	Zip:
Telephone:

Purchasing Contact:
Accounts Payable Contact:
Bank Details
Bank Name:
Branch:
Address:
City:
State:	Zip:
Telephone:
Fax:
Trade Reference
1. Name:
Address:
Address 2:
City:
State:	Zip:
Acct. No.
Contact:
Telephone:

2. Name:
Address:
Address 2:
City:
State:	Zip:
Acct. No.
Contact:
Telephone:

3. Name:
Address:
Address 2:
City:
State:	Zip:
Acct. No.
Contact:
Telephone:
Officer Information
Name of Principal Officer:
Home Address:
Address 2:
City:
State:	Zip:
Telephone:
Secondary Officer is Optional;
Name of Secondary Officer:
Home Address:
Address 2:
City:
State:	Zip:
Telephone:
Check One:	Corporation Partnership Sole Proprietorship

All information will be processed and kept confidential. Please note that all balances over 30 days will be charged a 1.5% finance charge on the total balance accrued monthly. Any accounts overdue without response to inquiries will be turned over for collection, and customer will be responsible for all legal fees and interest charges incurred in the process. If you have any questions regarding this policy call 717-697-1999 or fax 717-697-2452.
You must complete the Purchase Order below with your Credit Application before Application will be accepted.
Purchase Order
Purchase Order Number:
Project Name:
Project Location:
Product:	Qty:
Product:	Qty:
Product:	Qty:
Product:	Qty:


Upon credit approval, you will be faxed an order confirmation form to be signed and returned to Fax 1-717-697-6141 or Toll Free Fax 1-800-634-7906

To Complete Credit Application:
Checking the box below is your electronic signature. By clicking the "Submit Request" button, you agree to the above payment terms and terms of sale. By checking this box, I agree to the above payment terms on my account.

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