Somerset Plastics Credit Reference Form
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16 Fillmore Ct. Suite 302
Monroe, NY 10950
Toll Free: 888-766-6653
P: 845-783-6565 F: 206-350-3143
:
E
Credit Reference Form
Company Name:
Phone:
Fax:
_____________________________________________________________________________________
Address:
City:
State:
Zip:
Corporate Officer: __________________________________Title:_______________________________
Nature of Business: _____________________________________________________________________
Date Business Was Started: ________________
Federal Tax ID#:__________________
Annual Sales Revenue: ___________________
No. of Employees_________________
Accounts Payable Contact: ________________
Web Site: _______________________
Trade References:
Company Name:
Contact:
Phone:
Fax:
1_____________________________________________________________________________________
Address:
City:
State:
Zip:
Company Name:
Contact:
Phone:
Fax:
2_____________________________________________________________________________________
Address:
City:
State:
Zip:
Company Name:
Contact:
Phone:
Fax:
3_____________________________________________________________________________________
Address:
City:
State:
Zip:
Bank Reference:
Bank Name:_______________________________Account NO. __________________
Address: ______________________________________________________________________________
Contact:_________________________Phone________________________Fax_____________________
I authorize the above stated references to provide Somerset Plastics. with any information
in their possession regarding their business experience with my company or me.
Signature: ____________________________
Print Name: _____________________________
Title: ________________________________
Date: ___________________________________
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Parent category: Financial