Application For Credit  
 
 
ApplicantBusiness InformationTrade ReferencesBank ReferencesAdditional NotesConfirmation
               
  Business Name:  

 
  Parent Company Name:  

 
  Billing Address:  

 
  City:         State:         Zip:  

    Only fill out street address if billing address is different.

 
  Street Address:  

 
  City:         State:         Zip:  

  Phone:            Fax:  

  HALO Sales Representative:  

 
  Credit Limit Requested:  

 
 
 
 
NOTE: No Information will be saved until you click the "submit" button on the Confirmation tab.
The turn around time for processing this application is 2 to 5 business days, depending on the response time of your references.