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ROBINSON SALT SUPPLY, INC.
1202 PINE KNOLL COURT
MIAMISBURG, OHIO  45342
(937) 866-7272                                                  
(614) 857-9100
Outside Ohio 1-800-898-7258 (SALT)
Fax (937)866-3071

WWW.ROBINSONSALTSUPPLY.COM


Date: _____________

Name:__________________
Address: _______________
________________________
Phone:_________________
Fax:____________________
Email:__________________

To: _______________

Please provide three (3) credit references with your application for credit. Please include: Business name,
Contact person, Business phone number, and Fax numbers.

Without this information, it will delay the processing of your account for credit.

1) _____________________________________________________________________   
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
2) _____________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
3) _____________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

Thanks for your assistance in this matter.

Robinson Salt Supply, Inc.