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Credit Application
Credit Application
Company Information
Company Name:
Owner's Name
Billing Address:
City:
State:
Zipcode:
Phone:
Fax:
Accounts Payable Information
A/P Representative:
A/P Phone Number:
A/P Email Address:
OK To Email Invoices?
Yes
No
Federal Tax ID:
CA Resale Certificate:
(California Businesses Only)
Company Website Address:
(If Applicable)
Years at Present Address:
Ever Filed for Bankruptcy?
Yes
No
Credit References
Company #1:
Account #:
Phone #:
Fax #:
Annual Purchases:
Company #2:
Account #:
Phone #:
Fax #:
Annual Purchases:
Company #3:
Account #:
Phone #:
Fax #:
Annual Purchases:
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