CREDIT APPLICATION
CUSTOMER NAME____________________________________________________________
BILLING ADDRESS____________________________________________________________
CITY_________________________________________ STATE________ ZIP___________
TELEPHONE_________________ CONTACT NAME________________________________
YEARS IN BUSINESS _______ OWNER / PRESIDENT _______________________________
CORPORATION_________ PARTNERSHIP_______OTHER___________________________
SHIP TO NAME _______________________________________________________________
SHIP TO ADDRESS ____________________________________________________________
CITY_____________________________________STATE____________ ZIP______________
DO YOU
HAVE A RESALE CARD? (Y/N)_______ RESALE #____________________________________
CHARGE SALES TAX ? (Y/N) ____________
PLEASE LIST THREE COMMERCIAL CREDIT REFERENCES
1. NAME__________________________________________________________________
ADDRESS____________________________________________PHONE_____________
2. NAME__________________________________________________________________
ADDRESS____________________________________________PHONE_____________
3. NAME___________________________________________________________________
ADDRESS____________________________________________PHONE_____________
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NAME OF BANK______________________________________PHONE_____________
COMMERCIAL CHECKING
ACCOUNT #_____________________________________
RETURN VIA FAX TO 510-632-6760