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BUSINESS CREDIT APPLICATION
Company Name
Type of Business
Phone Number
Fax Number
Billing Address
City
State
Zip
Shipping Address
City
State
Zip
Type of Ownership
Corporation Partnership Sole Proprietor
Government Non-Profit
Years in Business
Tax Exempt? Yes No
(If yes, please include resale card with application)
Parent company names
(If different than above)
Address
Fax Number
City
State
Zip
BANK REFERENCES
Name 1
Phone Number 1
Fax Number 1
Account Number 1
Contact 1
Name 2
Phone Number 2
Fax Number 2
Account Number 2
Contact 2
OPEN ACCOUNTS REFERENCES
Name
Phone Number
Fax Number
Account Number
Contact
Name
Phone Number
Fax Number
Account Number
Contact
Name
Phone Number
Fax Number
Account Number
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