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Conveyors
& Drives, Inc.
APPLICATION FOR CREDIT
DATE:_______________________
ISSUED TO: Conveyors & Drives, Inc
FIRM NAME: (NAME OF FIRM REQUESTING STATEMENT)
______________________________________________________________
MAILING ADDRESS: _____________________________________
PHONE:_____________________
CITY: __________________ STATE: ______________ ZIP CODE: ______________
FULL NAME OF OWNER OR OWNERS (OR AN AUTHORIZED OFFICER OF CORP)
LIST HOME ADDRESS & ZIP CODE FOR PARTNERSHIP OR INDIVIDUAL.
1.________________________________________________________________
2.________________________________________________________________
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PLEASE CHECK ONE: |
INDIVIDUAL |
PARTNERSHIP |
CORPORATION |
FED. TAX NO. |
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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)_______________________________________________________________
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NAME OF BANK: |
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CONTACT: |
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ACCOUNT NO: |
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MAILING ADDRESS: |
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CITY / STATE / ZIP |
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APPLICANTS SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND
WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH FOLLOWING TERMS: NET 30
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