APPLICATION FOR CREDIT

APPLICATION FOR CREDIT
Company Information:
Name of Company or Individual requesting credit:
Company or Individual Name

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail:
E-mail
Phone Number:

Area Code Phone Number
Fax Number:

Area Code Phone Number
Billing Address and Accounting Contacts:
Name of Company (if different from above):
Company Name
Name of Contact Person (Accounts Payable):
Company Name

Billing Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail:
E-mail
Phone Number:

Area Code Phone Number
Fax Number:

Area Code Phone Number
Ownership:
Business Type:
Name of Principal #1:
Individual Name

Address of Principal #1:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Principal #1:
E-mail
Phone Number of Principal #1:

Area Code Phone Number
Fax Number of Principal #1:

Area Code Phone Number
Name of Principal #2 (if applicable):
Individual Name

Address of Principal #2 (if applicable):

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Principal #2 (if applicable):
E-mail
Phone Number of Principal #2 (if applicable):

Area Code Phone Number
Fax Number of Principal #2 (if applicable):

Area Code Phone Number
Bank/Finance References:
Bank Name:

Bank Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Bank Phone Number:

Area Code Phone Number
Bank Fax Number:

Area Code Phone Number
Branch Manager Name (or other Bank Contact, please list Name and Title):
Bank Contant Name and Title
Trade References:

Please provide 3 Trade References
Name of Trade Reference #1:
Business Name

Address of Trade Reference #1:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Trade Reference #1:
E-mail
Phone Number of Trade Reference #1:

Area Code Phone Number
Name of Trade Reference #2:
Business Name
Fax Number of Trade Reference #1:

Area Code Phone Number

Address of Trade Reference #2:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Trade Reference #2:
E-mail
Phone Number of Trade Reference #2:

Area Code Phone Number
Fax Number of Trade Reference #2:

Area Code Phone Number
Name of Trade Reference #3:
Business Name

Address of Trade Reference #3:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail of Trade Reference #3:
E-mail
Phone Number of Trade Reference #3:

Area Code Phone Number
Fax Number of Trade Reference #3:

Area Code Phone Number
Application Signature:

By entering your Name, Title and Date below you certify that all information on this form is correct. You also certify that you fully understand our credit terms and agree to the proper payment in consideration of extended credit. You further agree that cash sales will be acceptable until acknowledgement of credit approval from Tri-County Packaging is received.
Signature:
Name of Individual completing this Application for Credit
Title:
Title of Individual completing this Application for Credit
Date:
Today's date
Should be Empty: