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Credit Application

If you would rather complete the credit application offline instead of through the following online form, you can download the PDF version of the credit application here.

(*) required

[1] Contact Information:
Company Name:
Travers Account #:
First Name:*
Last Name:*
Title:
Department:
Phone #:*
Fax #:
Email Address:
Verify Email Address:

[2] Billing Information:
Address 1:*
Address 2:
City:*
State/Province:*
  (Select "Other" if not in USA or Canada)
Zip Code/Postal Code:*
Country:*
Phone #:*
Fax #:
Email Address:

[3] Shipping Information:
 Shipping Address same as Billing Address
 If the Shipping Address is different than than the Billing Address, please fill in the section below.
Address 1:
Address 2:
City:
State/Province:
  (Select "Other" if not in USA or Canada)
Zip Code/Postal Code:
Country:
Phone #:
Fax #:
Email Address:

[4] Dun & Bradstreet Information
(if you are unlisted in D&B, please proceed to sections 5 and 6):
Duns ID #:

For those companies not well rated in D&B, please provide the following in sections
[5] Banking Reference & [6] Trade References below

[5] Banking Reference:
(Please give full name, address, phone and fax numbers on reference)
Bank Name:
Bank Account #:
Contact First Name:
Contact Last Name:
Address 1:
Address 2:
City:
State/Province:
  (Select "Other" if not in USA or Canada)
Zip Code/Postal Code:
Country:
Phone #:
Fax #:
Email Address:

[6] Trade Reference:
(Please give full name, address, and phone numbers on all references)

1st Trade Reference:
Company Name:
Contact First Name:
Contact Last Name:
Address 1:
Address 2:
City:
State/Province:
  (Select "Other" if not in USA or Canada)
Zip Code/Postal Code:
Country:
Phone #:
Fax #:
Email Address:

2nd Trade Reference:
Company Name:
Contact First Name:
Contact Last Name:
Address 1:
Address 2:
City:
State/Province:
  (Select "Other" if not in USA or Canada)
Zip Code/Postal Code:
Country:
Phone #:
Fax #:
Email Address:

3rd Trade Reference:
Company Name:
Contact First Name:
Contact Last Name:
Address 1:
Address 2:
City:
State/Province:
  (Select "Other" if not in USA or Canada)
Zip Code/Postal Code:
Country:
Phone #:
Fax #:
Email Address:

[7] Company:
Please indicate which pertains to your company:
Individual Ownership  Partnership  Corporation  Other
 
Enter the characters you see:
 
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Phone: 1.800.221.0270 (Local & International: 718.886.7200) • Fax: 1-800-722-0703 (Local & International: 718-886-7895)

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