Abel Womack
One International Way
Lawrence, MA 01843
PHONE 800-554-2887 X688 FAX 978-989-9401
Email:
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PLEASE FILL OUT THE FOLLOWING CREDIT APPLICATION, PRINT, AND FAX IT TO:
Abel Womack @ 978-989-9401
APPLICATION FOR CREDIT
DATE:_______________________
ISSUED TO: Abel Womack
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 CORPORATION)
LIST HOME ADDRESS & ZIP CODE FOR PARTNERSHIP OR INDIVIDUAL.
1._________________________________________________________________________________
2._________________________________________________________________________________
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)___________________________________________________________________________________
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 10
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