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.