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COMPANY INFORMATION
Company Name: _________________________________________________________
Address:
________________________________________________________________
City, State:
______________________________________________________________
Zip Code:
________________ Phone: __________________ Fax:
__________________
Principal:
________________ Principal: ______________Years of Ownership:
_______
Tax Exempt: ____Yes ____No Type of Business:
______________________________
(IF YES, PLEASE ATTACH EXEMPTION CERTIFICATE)
TRADE REFERENCES
Name: __________________________________________________________________
Address:
________________________________________________________________
City, State:
______________________________________________________________
Zip Code: _______________ Phone:
__________________ Fax: __________________
OFFICE USE ONLY
Terms: __________
Pay: __________ Balance: __________
High:
__________ Length: __________
Comments:
___________________________________________________________________________ |
Bank Name: ________________________ Acct. #:
_____________________________
Address:
________________________________________________________________
City, State:
______________________________________________________________
Zip Code: _________________ Phone:
________________ Opened: _______________
Account Type:
_________________________ Rating: ___________________________
In the event legal suit is instituted for the collection of
any amount due on an invoice, purchaser agrees to pay costs of suit and reasonable
attorney's fees.
I/WE PERSONALLY AGREE TO PAY FOR ALL PURCHASES FOR THE ABOVE
NAME APPLICANT IN ACCORDANCE WITH YOUR TERMS OF SALES.
Debtor Company Name:
___________________________________________________
By:
_______________________ Title: ____________________ Date:
_______________
Authorized Signature: ________________________________ Date:
______________
Miller Pacific Steel found it necessary to
request our customers to fill out this form.
Most banking institutions require an authorized release form
in order to obtain the required banking information needed to complete our credit
application.
Please complete the following:
I authorize (your bank institute) to release information
pertaining to my account (your acct number)
to Miller Pacific Steel.
Authorized Signature:
_______________________________ Title: ________________
Bank's Name:
____________________ Account Number: _______________________
Thank You,
Miller Pacific Steel |
