Case Parts Company Credit Reference Form
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1Credit Reference Form
Company Information
Company Name:
_____________________________________________________
Address:
_____________________________________________________
City/State/Zip:
_____________________________________________________
Phone:
(____)_____-______
Fax:
(____)_____-______
Contractor’s License: ______________________________________ State: _________
Resale Permit No:
______________________________________ State: _________
Principal/Owner:
_____________________________________________________
Phone:
(____)_____-______
A/P Contact:
_____________________________________________________
Phone:
(____)_____-______
Fax:
(____)_____-______
Trade References
Company Name:
_____________________________________________________
Address:
_____________________________________________________
City/State/Zip:
_____________________________________________________
Phone:
(____)_____-______
Fax:
(____)_____-______
Company Name:
_____________________________________________________
Address:
_____________________________________________________
City/State/Zip:
_____________________________________________________
Phone:
(____)_____-______
Fax:
(____)_____-______
Principal/Owner Signature:
______________________________________ Date: __________
Los Angeles P: 800-421-0271
St. Louis P: 800-423-9337
Seattle P: 800-715-3416
F: 800-972-2441
F: 800-262-3974
F: 800-714-1257
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Parent category: Financial