100% Solid Brass Decorative Accessories
  Stair Rods
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 Credit Application for Interested Dealers
 Request a Catalog
 For Dealers Near You
 If you want to fax or mail your application please click here for a printable version of the Customer Credit Application

Customer Credit Application

Contact First Name:

Contact Last Name:

Company Name:

Address 1:

Address 2:

City:   State:   ZipCode:

Phone Number:

Fax Number:

E-Mail:

Tax ID Number:

Bank Name:

Bank Branch:

Bank Phone Number:

Reference #1

Contact:

Company Name:

Address:

City:   State:   ZipCode:

Phone Number:

Fax Number:

Reference #2

Contact:

Company Name:

Address:

City:   State:   ZipCode:

Phone Number:

Fax Number:

Reference #3

Contact:

Company Name:

Address:

City:   State:   ZipCode:

Phone Number:

Fax Number:

By clicking on the "Submit" button below, you authorize Brass Elegans, Inc. to perform a credit check for the purpose of opening credit with us.

An Elegant Touch of Brass