Business Bank & Trade Reference Sheet printable pdf download

Business Bank & Trade Reference Sheet

Please complete the following information and fax to (910) 862-2894 or mail to: Campbell Oil Company,

PO Box 637 Elizabethtown, NC 28337, Attn: Credit Dept.

Company Name: __________________________________ Tax I.D. Number__________________

Owner/s of Company: ____________________________________ SS # _____________________

Company Status: Incorporated _____ Partnership _____ Sole Owner ______

Billing Address: ________________________City: ____________ State: _______ Zip _______

Phone: (_____) ____________________

Fax# (_____) __________________

Accounts Payable Contact: ____________________________________________

$___________________________________

Credit Limit Requested

For requests in the amount of $10,000 or more, we ask that you attach your most recent financial statement

(If Different From Above)

Delivery Address:___________________________City:__________State:______ Zip________

Contact Name: _______________________________ Phone: (______) __________________

Does Your Company Require a Purchase Order # ______Yes ______ No

Bank & Trade References

(Please provide a least one Fuel or Lubricant Co. provider)

Bank: ___________________________________ Acct#: ______________________________

Address: ___________________________ City: ________________ St:_______ Zip ________

Contact Name:___________________________ Phone: (____)________ Fax: (___)__________

Trade Reference: ________________________________ Acct #: _____________________

Address: _________________________ City: _________________ St: ________Zip ________

Contact Name: __________________________ Phone: (____)_________Fax: (___)__________

Trade Reference: ________________________________ Acct #: _____________________

Address: _________________________ City: _________________ St: ________Zip ________

Contact Name: __________________________ Phone: (____)_________Fax: (___)__________

Trade Reference: ________________________________ Acct #: _____________________

Address: _________________________ City: _________________ St: ________Zip ________

Contact Name: __________________________ Phone: (____)_________Fax: (___)__________

By signing below, I am stating that I am an authorized representative of the company and I am giving CAMPBELL OIL & GAS CO. permission

to request credit information from the above references and I understand that a credit check will be ran on the company &/or owner of company.

Date

Signature

: ______________________________________

: ___________________________

Please Print Name and Title

: _____________________________________________________________________

Business Bank & Trade Reference Sheet