Credit Processing Form Page 2
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1
2C R E D I T P R O C E S S I N G F O R M
COMPANY INFORMATION
Business Name
President/Owner
Years in Business
Billing Address
City
State
Zip
Phone
Fax
State Tax ID # / Resale #
Federal Tax ID #
Shipping Address
City
State
Zip
Phone
Fax
Accounts Payable Contact Name
Email Address
Phone
Fax
Buyer Contact Name
Email Address
Phone
Fax
PRIMARY BANK INFORMATION
Bank Name
Contact Name
Billing Address
City
State
Zip
Phone
Fax
I hereby certify that the information contained herein is complete and accurate. This information has been furnished
with the understanding that it is to be used to determine the amount and conditions of the credit to be extended.
Signature_____________________________________ Date__________________________
Title________________________________________________________________________
Please Note:
This form must be accompanied by
Please fill out and return to
an attached sheet of at least 4 credit
papaya! by any of these means:
references to be processed. Reference
Fax:
877-772-7292
sheets must include the following
Mail:
582 Parsons Dr.
information: company name, contact
Medford OR 97501
name, fax number, phone number, and
Email:
your account number with referenced
company
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Parent category: Financial