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Application for Credit



Name of Firm or Individual


Tax ID # or S.S.#


Address


Years at this address:

City


State


Zip


Owner of Company


Accounts Payable Manager


Telephone


Fax


Email Address


HEREBY applies for credit in accordance with the terms and conditions of:
Credit Manager


Our Normal Credit Terms



The following information must be provided. It will be held in the strictest confidence.

Corporation     Check here if incorporated in the last 12 months     Partnership     Individual

Name of Principal(s)


Complete Address


United States References