Hillary Machinery Inc
www.hillaryinc.com
(800)683-1516 FAX (972)578-1519

New Account Web Form

 
COMPANY INFORMATION: All Applicable Fields Required.
   Company Name:
                Corporation, State 
                Sole Proprietor, Proprietor Name 
                Partnership, Partner 1 Name 
                               Partner 2 Name 
                               Partner 3 Name 
       Primary A/P Contact:                       
   Primary Billing Address: 
      Primary Billing City:  State ZIP
     Primary Billing Phone:  FAX 
     Primary Billing Email: (Optional) 
   Shipping Address (If different from above)
    City/State ZIP
3 TRADE REFERENCES: All Fields Required  (WE REALLY NEED THE FAX NUMBERS)
     Trade Name                           City & State  (AC)Phone             (AC)FAX
        
        
        
BANK INFORMATION: All Fields Required

           Bank Name: 
    Bank City/Branch: 
    Bank Voice Phone: 
            Bank Fax: 
 Bank Account Number: 
 PAYMENT TERMS: Parts- Net 10 days After Delivery; Purchase Order Required
                Machinery- Refer to Proposal
Agreed? Yes  No

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