WHOLESALE Credit Application
*
Entry Required
Company Profile
*
Firm Name:
dba:
*
Contact Person:
*
Address:
*
Phone:
Fax:
*
e-mail:
Type of Business:
CORPORATION
PARTNERSHIP
SOLE PROPRIETOR
OTHER
Date Established:
Owners/Officers:
Description of Business:
Billing Information
*
State Tax ID:
*
Federal EIN:
Buyer:
Phone:
Persons to
contact in case the account becomes overdue:
Phone:
Bank Reference:
Name:
Branch:
