Cook Specialty Co., Inc.

Cook Specialty Home

Credit Application

Application Date
Your first Name
Your Last Name
Company Name
E-mail
Address
City, State, Zip
Telephone Number
County Name (WI Only)

Reference 1
Company Name
Contact person/Number
Address
City, State, Zip
E-mail
Telephone Number
Terms & Credit Limit
Reference 2
Company Name
Contact person/Number
Address
City, State, Zip
E-mail
Telephone Number
Terms & Credit Limit
Reference 3
Company Name
Contact person/Number
Address
City, State, Zip
E-mail
Telephone Number
Terms & Credit Limit
People Authorized to Purchase
Comments

Tax Exemption Form	(A fillable PDF is available from the Wisconsin Department of Revenue at http://www.revenue.wi.gov/forms/sales/s-211f.pdf. Please fill out the form, sign and submit with your application.)
Business License	(We require that you provide us with a copy of one of the following licenses: food/health, sales tax, bakery or state sellers number.)