Contact Us

Company Information:

Legal Company Name (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Phone (required)

Fax

Year Established

Number of Employees

Estimated Annual Sales

Federal Tax ID Number

Exempt from Sales & Use Tax:
Yes No (*If yes, please email/fax a copy of exemption certificate.)

Type of Business:
Sole Proprietorship Partnership Corporation LLC

A/P Contact Name

A/P Contact Phone

A/P Contact Email

Purchase Order Required:
Yes No

Bank References:

Bank Name

Bank Address

Bank Contact Name

Bank Phone

Bank Fax

Trade References:

Baltimore Hydraulics, Inc. requires THREE (3) references where you have credit established. (Not prepay accounts)

Company One

Company Name

Contact Name

Title

Phone

Fax

Email

Company Two

Company Name

Contact Name

Title

Phone

Fax

Email

Company Three

Company Name

Contact Name

Title

Phone

Fax

Email

Please note that it typically takes 3-5 business days to process an application; however some suppliers will respond only in writing which may delay the approval of some applications. We ask that the credit application be completed in its entirety. Upon approval of application, all invoices are due 30 days from invoice date with no discount. This credit application is valid for a period not to exceed two (2) years from approval date. Credit can be withdrawn at any time for violation of stated credit terms. All information will remain in strict confidence with Baltimore Hydraulics, Inc.'s Accounting Department.

Agreement & Signature:

I/We expressly consent to Baltimore Hydraulics Inc. to obtain any reports containing credit or personal information that is required in obtaining credit with Baltimore Hydraulics, Inc. I/We declare that the information given on this application is true and accurate. This declaration is made for the purpose of obtaining credit with Baltimore Hydraulics, Inc. and will remain confidential.

Signature Name (I understand that this name will constitute a digital signature of this form.)

Date