Credit Application

A Few quick and Easy steps to help Expedite your Credit Application!

  1. Complete the application in its entirety.
  2. If you have a preprinted Company reference sheet, complete only the grey areas of the credit application.
  3. Provide 4 references. We require 3 for approval, but giving us four you increase the number of responses we can receive.
  4. Make sure your references have valid fax numbers and phone numbers.
  5. If tax exempt, please include a valid Florida Tax Certificate (DR-13).
  6. Once everything is completed, fax to 321-282-6115 or email to

Click here to download Credit Application.

Once we receive your application, we will begin processing it right away.

Thank you for applying with Amazon Hose & Rubber Company, we look forward to working with you!

You can also fill out our Online Credit Application!