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Confidential Application for Credit

Section A | Type of Business (Please Select)

Corporation
State of Incorporation:
Year:
Partnership
Other

Section B | General Information

Company Name:
Address:
City:
 State:  
Zip:
 
Phone:
    
Fax:
 
Years in Business:
   
President:
Number of
Employees:
Accounts Payable Contact:
Annual Purchases:
Annual Sales:

Section C | References

Bank:
Account #:
Contact:
Address:
City:
State:
Zip:
Phone: Fax:
Bank:
Account #:
Contact:
Address:
City:
State:
Zip:
Phone: Fax:

Bank:
Account #:
Contact:
Address:
City:
State:
Zip:
Phone: Fax:

Tax Status: Taxable Exempt #: