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Culver-Hahn
Electric Supply

2001 15th Sreet SW
Mason City, Iowa 50401
Phone: 641-423-6343
Toll Free: 1-800-392-2320
Fax: 1-641-423-2513
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New Accounts

Please fill out the attached forms as completely as possible. Kindly include complete mailing addresses and phone numbers on all credit and bank references. You may attach a copy of your current prepared financial statement in lieu of using the format on the second page of the credit application, but the original application must be signed on the back and returned to us before an open account may be established. Facsimile copies can not be accepted.

You will also need to complete and sign the "Sales and Use Tax Exemption Certificate". If you are not exempt from sales or use taxes, please draw a diagonal line through the form, sign, and return it to us with your credit application. This will indicate that you want your purchases from us to be taxable.

Thank you for your help - prompt return of these forms will enable us to begin our review without delay.
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