FORM C
CREDIT APPLICATION FORM| Store
Name: |
Years in
Business: |
| Street
Address: |
City/State/Zip:
|
| Telephone
Number: |
Fax Number: |
| E-Mail
Address: |
Federal ID#: |
| Buyer's
Name: |
Type of
Business: |
| Owner
#1: |
Owner #2: |
| Street
Address: |
Street
Address: |
| City/State/Zip: |
City/State/Zip:
|
| Phone
Number: |
Phone Number:
|
| Fax
Number: |
Fax Number: |
| E-Mail: |
E-Mail: |
| Bank
Name: |
Account
Number: |
| Street
Address: |
Contact
Person: |
| City/State/Zip:
|
Phone: |
CREDIT REFERENCES
| Reference One | |
| Name: |
Address: |
| Contact: |
Phone Number
(list an 800 # if available): |
| Reference Two | |
| Name: |
Address: |
| Contact: |
Phone Number
(list an 800 # if available): |
| Reference Three | |
| Name: |
Address: |
| Contact: |
Phone Number
(list an 800 # if available): |