Customer Credit Application Page 3
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10Contact person____________________________________ Phone No._____________________
Creditor___________________________ Account No.________________ Year opened______
Address______________________________ City___________ State_______ Zip code_______
Contact person____________________________________ Phone No._____________________
Creditor___________________________ Account No.________________ Year opened______
Address______________________________ City___________ State_______ Zip code_______
Contact person____________________________________ Phone No._____________________
Purchasing Information
Does your company employ a purchase order number system? Yes __ No __
If Yes: .Verbal __ Written ___
List all persons authorized to make purchases:
Name:_______________________________________________
Billing Address: _____________________________________________
Shipping Address: _____________________________________________
City/State: ______________________________Zip: _______________
Phone #: __________________________________________________
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Parent category: Business