Credit Application

Thank you for taking the time to complete a credit application with Midlantic Supply, LLC. To ensure a smooth and timely review process, please complete the credit application in its entirety. All requested information is vital for us to process your application, so please do not omit any fields.

Be sure to include:

  • Full addresses (including zip codes)
  • Job titles
  • Social Security Numbers
  • Phone and fax numbers
  • Bank and trade account numbers
  • Authorized signatures

Note: Incomplete applications may result in a delay in establishing your credit line.

Download Application

How to Submit

Once completed, please submit your application using one of the methods below. Thank you for your prompt attention!

Newspaper Clipping Icon

Submit via Fax

Fax number 856-778-4933. Important: If you choose to fax your application, please also mail the original copy to our office.

Envelope Icon

Submit via Mail

Midlantic Supply, LLC
P.O. Box 506
Mount Laurel, NJ 08054