|
PLEASE FILL OUT THE FOLLOWING CREDIT APPLICATION,
PRINT, AND FAX IT TO:
CENTURY CONVEYOR SERVICE, INC. @
732-248-4960
APPLICATION FOR CREDIT
DATE:_______________________
ISSUED TO: CENTURY CONVEYOR SERVICE, INC.
FIRM NAME: (NAME OF FIRM REQUESTING STATEMENT)
___________________________________________________________________________________
MAILING ADDRESS: _____________________________________
PHONE:_____________________
CITY: __________________ STATE: ______________ ZIP CODE:
_____________________________
DUN & BRADSTREET REFERENCE NUMBER:
___________________________________________
FULL NAME OF OWNER OR OWNERS (OR AN AUTHORIZED OFFICER OF CORPORATION)
LIST HOME ADDRESS & ZIP CODE FOR PARTNERSHIP OR INDIVIDUAL.
1._________________________________________________________________________________
2._________________________________________________________________________________
|
PLEASE CHECK ONE: |
INDIVIDUAL |
PARTNERSHIP |
CORPORATION |
FED. TAX NO. |
|
|
|
|
|
|
ADDITIONAL INFORMATION REQUIRED FOR CONDITIONAL SALES CONTRACTS UNDER
THE UNIFORM COMMERCIAL CODE.
DEBTOR INDIVIDUAL SIGNING CONTRACT: ______________________________________________
TITLE:___________________________________
DEBTORS SOCIAL SECURITY NO: (FOR PARTNERSHIP OR INDIVIDUAL)_____________________
TYPE OF BUSINESS __________________________________
DATE STARTED_______________________
WE EXPECT OUR MONTHLY CREDIT REQUIREMENTS FROM YOU TO BE ABOUT
$______________________
FORMER BUSINESS ________________________________ LOCATION
______________________
OWN OR RENT BUILDING - IF RENT, FROM
WHOM?_______________________________________
REAL ESTATE MORTGAGE:____________________________________________________________
TRADE REFERENCES
NAME MAILING ADDRESS CITY STATE ZIP
1)___________________________________________________________________________________
2)___________________________________________________________________________________
3)___________________________________________________________________________________
|
NAME OF BANK: |
|
|
CONTACT: |
|
|
ACCOUNT NO: |
|
|
MAILING ADDRESS: |
|
|
CITY / STATE / ZIP |
|
APPLICANTS SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND
WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH FOLLOWING TERMS: NET 10
|
