|
410
washington st salisbury md 21804 |
| APPLICATION FOR CREDIT | CONFIDENTIAL |
Please print and return to above
address.
|
DATE _______________ |
| BUSINESS/CORPORATE NAME _______________________________ | d/b/a or (trade style) _______________________________ |
| _______________________________ | MAILING ADDRESS _______________________________ |
| _______________________________ | _______________________________ |
| Street | Street |
| _______________________________ | _______________________________ |
City
State
Zip |
City
State
Zip |
TELEPHONE NUMBER _________________________________
PARENT COMPANY________________________________________________
|
Name |
Address |
Company Profile
Corporation _______ Partnership _______ Limited Partnership _______ Franchise _______
Date you started business or assumed control ___________ Nature/Type of Business ____________________
If under 1 year, personal
guarantee required. Provide 2
personal references:
NAME AND TELEPHONE NUMBER
_________________________________
NAME AND TELEPHONE NUMBER
_________________________________
| ______________________ |
________________________________________
|
| No. of Employees |
Name
and address of Previous:
BusinessEmployer
|
Officers or Principals:____________________________________________________________
_______________________________________________________________________________
NameTitleResidenceSS#
_______________________________________________________________________________
NameTitleResidenceSS#
_______________________________________________________________________________
NameTitleResidenceSS#
Has Corporation been registered with the Secretary of State? __________
What State ___________ Date of Filing ___________
Credit References:
Media/Trade References:
_______________________________________________________________________________
NameStreetCityStateZipPh.Acct.#
_______________________________________________________________________________
NameStreetCityStateZipPh.Acct.#
_______________________________________________________________________________
NameStreetCityStateZipPh.Acct.#
BANK REFERENCES:
C–CheckingS–SavingsM–Mortgage/LoanCPD–Charge
_______________________________________________________________________________
NameStreetCityStateZipPh.Acct.#
_______________________________________________________________________________
NameStreetCityStateZipPh.Acct.#
I certify that the information provided in the application is true and correct. I hereby authorize the release of credit information requested relevant to the above account.
______________________________________________________________________________
Signature of OfficerTitleDate