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CREDIT1
| CREDIT ACCOUNT APPLICATION DATE ________________________ R & I SHOP HEAVY DUTY & LIGHT TRUCKS 2695 Kee Moore Drive Chester, SC 29706 Phone: (803) 789-5635 Fax: (803) 789-5101 BUSINESS TYPE: __ Sole Proprietorship __Partnership __Corporation – In State of ____ Number of years in business___________________ D and B Number ____________________ COMPANY NAME ____________________________________________________________ ADDRESS _____________________________________________________________________ CITY ______________________________ STATE ______________________ ZIP __________ NAME AND ADDRESS OF INDIVIDUALS OR PARTNERS – NAME/TITLE/PHONE NUMBER OF CORPORATE OFFICERS ___________________________________________________________________________________________ ____________________________________________________________________________________________ NAME OF PERSON TO CONTACT REGARDING PURCHASE ORDERS AND INVOICE PAYMENT, TITLE, ADDRESS AND PHONE NUMBER ______________________________________________________________ _________________________________________ ______________________________________________________________ ___________________________________________ _____________________________________________________________ ____________________________________________ BANK REFERENCE BANK ACCOUNT NUMBER, CONTACT, TITLE AND PHONE NUMBER ___________________________________________________ ____________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ____________________________________________________ TRADE REFERENCES: COMPANY NAME, ADDRESS, CONTACT AND TITLE, AND PHONE NUMBER _____________________________________ ___________________________________________ __________________________ _____________________________________ ___________________________________________ __________________________ _____________________________________ ___________________________________________ __________________________ _____________________________________ ____________________________________________ _________________________ THE ABOVE INFORMANTION IS HEREWITH SUBMITTED FOR SIGNED ___________________________________________ THE PURPOSE OF OPENING AN ACCOUNT AND I DO HEREBY CERTIFY THIS INFORMATION TO BE TRUE. TITLE ______________________________________________ DATE _______________________________________________ NOTES ON ACCOUNT APPLICATION _____ APPROVED _____DISAPPROVED – REASONS _______________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ |
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