Printable Commerical Account Application

APPLICATION FOR CREDIT
Print this form and fax to (415) 822-2689
or use our online credit app!

ALL INFORMATION ON THIS APPLICATION WILL BE HANDLED DISCREETLY AND KEPT IN STRICTEST CONFIDENCE

COMPANY INFORMATION:

CHECK ONE: ___CORPORATION ___PARTNERSHIP ___SOLE PROPRIETORSHIP ___INDIVIDUAL
OWNER: NUMBER OF YEARS IN BUSINESS:
PRESIDENT:
SECRETARY:
ARE ITEMS TO BE PURCHASED FOR RESALE? ___NO ___YES IF YES, PLEASE ENCLOSE A RESALE CERTIFICATE
FINANCIAL INFORMATION:
BANK NAME:
ADDRESS:	CITY:			STATE:			ZIP CODE:
ACCOUNT REPRESENTATIVE:			TELEPHONE:		D&B #:
REFERENCES: TO ENSURE PROMPT PROCESSING OF YOUR APPLICATION, PLEASE BE SURE TO INCLUDE PHONE AND FAX NUMBERS
COMPANY NAME:				CONTACT:
ADDRESS:		CITY:		STATE:		ZIP CODE:
TELEPHONE:				FAX:
COMPANY NAME:				CONTACT:
ADDRESS:		CITY:		STATE:		ZIP CODE:
TELEPHONE:				FAX:
COMPANY NAME:				CONTACT:
ADDRESS:		CITY:		STATE:		ZIP CODE:
TELEPHONE:				FAX:

I (WE) CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT AND THAT WE WILL COMPLY WITH YOUR ACCOUNT TERMS

RJLCA0497