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APPLICATION FOR OPEN ACCOUNT CREDIT

APPLICATION FOR OPEN ACCOUNT CREDIT

 FOR STOCKING DEALERS

 

 

(Please Fill Out Completely and Legibly)

COMPANY NAME:  ________________________________

D/B/A:  ___________________________________________

BILLING ADDRESS:  ______________________________________________________________________

______________________________________________________________________

SHIPPING ADDRESS:  ______________________________________________________________________

______________________________________________________________________

PHONE NUMBER:  ___________________________

FAX NUMBER:  ______________________________

OWNER(S) NAME:  ___________________________

SALES TAX NUMBER:  _______________________

BUYER:  ____________________________________

STORE SIZE:  ____________________________ SQ. FT.

BOOKKEEPER:  ______________________________

NUMBER OF EMPLOYEES:  ________________

NUMBER OF YEARS IN BUSINESS UNDER CURRENT OWNER:  ___________

PURCHASE SUBJECT TO SALES TAX?  [   ]  YES  [   ]  NO

PURCHASE ORDERS REQUIRED?  [   ]  YES  [   ]  NO

LINE OF CREDIT REQUESTED:  $____________________

 

TYPE OF COMPANY:  [   ]  SOLE PROPRIETORSHIP  [   ]  PRIVATE CORP.

                                        [   ]  PARTNERSHIP  [   ]  PUBLIC CORP.

                                        [   ]  OTHER ___________________________

 

TYPE OF BUSINESS:  [   ]  ANTIQUES  [   ]  CATALOG  [   ]  FLORIST

                                       [   ]  GIFTS  [   ]  DEPARTMENT

                                       [   ]  OTHER ___________________________

 

BANK BRANCH:  __________________________________

BANK CONTACT:  _________________________________

BANK ADDRESS:  _________________________________

PHONE NUMBER:  _________________________________

FAX NUMBER:  ____________________________________

ACCOUNT NUMBER:  ______________________________

 

TRADE REFERENCES

(Please give complete addresses and account number(s))

COMPANY:  ________________________________________

ADDRESS:  _________________________________________

PHONE:  _________________    FAX:  __________________

ACCOUNT NUMBER:  ________________________________

COMPANY:  ________________________________________

ADDRESS:  _________________________________________

PHONE:  _________________    FAX:  __________________

ACCOUNT NUMBER:  ________________________________

COMPANY:  ________________________________________

ADDRESS:  _________________________________________

PHONE:  _________________    FAX:  __________________

ACCOUNT NUMBER:  ________________________________

COMPANY:  ________________________________________

ADDRESS:  _________________________________________

PHONE:  _________________    FAX:  __________________

ACCOUNT NUMBER:  ________________________________

To the best of my knowledge the above facts are represented as true.  I am aware that falsification of any of this information may result in denial of credit by ____________

_________________________ Inc.  My signature below indicates my permission for ___________________________________ Inc., to obtain credit information from the sources I have referenced, including any external credit reporting source, and any consumer credit agency.  I understand that interest will be charged on all past due balances at a rate of ________% per month.

 

 

________________________________________________

AUTHORIZED INDIVIDUAL (Please Print)

 

________________________________________________

SIGNATURE

 

____________________________

DATE



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