COMPANY PRINCIPAL RESPONSIBLE FOR BUSINESS TRANSACTIONS
DESCRIPTION OF BUSINESS
Please describe your business:
Business Structure (Corp, Partnership, Etc.)
Number of Employees
Tax ID # (If applicable)
Parent Company (If applicable)
BANK REFRENCE
Bank Name
Account Number
Telephone Number
TRADE REFRENCES
Firm Name
Contact Name
Telephone Number
Fax Number
Open Since
Firm Name
Contact Name
Telephone Number
Fax Number
Open Since
Firm Name
Contact Name
Telephone Number
Fax Number
Open Since
SPECIAL INSTRUCTIONS
CONFIRMATION OF INFORMATION AND RELEASE OF AUTHORITY
I hereby certify that the information on this application is correct. Further, I authorize trade references listed in this application to release the necessary information to establish a line of credit.
Name
Title
Date
Security Code
Please type the security code you see in the image above into the box below:
