APPLICATION FOR CREDIT
| Company Name: |
Phone Number |
| Address |
Suite |
| City |
State: Zip: |
| Telephone: |
Fax: |
| Contact: |
Federal Tax ID#: |
| At Present Location Since |
Year Established |
| Years in Business: |
Date Started: |
| # of Employees: |
|
| Ownership Are you (please circle): |
Sole Proprietorship Partnership Incorporated |
| If incorporated, in the laws of what state? |
|
| Name of Proprietor and All Partners |
|
| 1) |
2) |
| 3) |
4) |
| Name of Parent Company if Subsidiary |
|
| If Sole Proprietor: |
|
| Name: |
Title: |
| Soc. Sec # |
|
| Address |
Suite |
| City |
State: Zip: |
| Telephone: |
Fax: |
| Credit and Trade References: (Please give only |
those you buy from on open account) |
| Company Name: |
Phone Number |
| Address |
Suite |
| City |
State: Zip: |
| Telephone: |
Fax: |
| Company Name: |
Phone Number |
| Address |
Suite |
| City |
State: Zip: |
| Telephone: |
Fax: |
| Company Name: |
Phone Number |
| Address |
Suite |
| City |
State: Zip: |
| Telephone: |
Fax: |
| Where do you bank? |
Account # |
| Address |
Suite |
| City |
State: Zip: |
| Landlord: (Contact) |
(Phone) |
Please circle the basis on which you usually pay merchandise bills: 30 Days 60 Days 90 Days
I hereby authorize the release of any business and/or personal credit, financial and depository information that may be requested by B & D Bolting or it's assigns.
Signed: ________________________________Date _________ By: _________ |