| Name |
|
| Title |
|
| Organization |
|
| Work Phone |
|
| Address |
|
| City |
|
| State/Province |
|
| Zip code/Postal code |
|
| Country |
|
| How Long At This Address |
Years |
| Taxable |
Yes, No |
| Tax Exemption # |
|
| Are Purchase Orders Required |
Yes, No |
| Do You Accept Backorders |
Yes, No |
| Real estate Owned |
Yes, No |
| Mortgages |
|
Do you pledge or Borrow
Against Your Accounts Receivables |
Yes, No |
Do You Pledge or Borrow
Against Your Inventory |
Yes, No |
|
TYPE
OF OWNERSHIP
|
|
| Partnership |
Name of Partners & Address
|
| Sole Ownership |
Name of Owner & Address
|
| Corporation |
Name of Officers & Titles (Date and State of
Incorporation)
|
| Other |
Explain
|
|
FINANCE
|
|
| Bank |
Account# |
| Phone |
|
| Address |
|
| City |
|
| State/Province |
|
| Zip code/Postal code |
|
| Country |
|
|
TRADE REFERENCES
|
|
| Name |
1.
2. |
| Address |
1. 2. |
| City |
1.
2. |
| State/Province |
1.
2. |
| Zip code/Postal code |
1. 2. |
| Country |
1. 2. |
| Phone |
1.
2. |
| |
|
| Name |
3.
4. |
| Address |
3. 4. |
| City |
3.
4. |
| State/Province |
3.
4. |
| Zip code/Postal code |
3. 4. |
| Country |
3. 4. |
| Phone |
3.
4. |
|
| Application for credit is herby
applied for and is to be used by your credit
department only. We (I) hereby agree to your terms as
stated and fully intend to abide by them. It is
further understood that any deviation of said terms
is strictly prohibited without the direct
authorization of Best Screw Products,
Inc. We understand that ownership of
merchandise remains in the name of seller until paid
in full |
| Name of Officer |
Date: |
| Title of Officer |
|
