"Complete Line of Industrial Tools & Supplies, Since 1965"

1711 Callens Rd. ~ Ventura, Ca. 93003 ~ (805) 656-0715 ~ fax (805) 644-1695

  **APPLICATION FOR CREDIT** pg.1

FIRM NAME:
BILLING ADDRESS:
STREET ADDRESS:
PHONE # FAX # E-MAIL:
AT PRESENT LOCATION SINCE: YEAR ESTABLISHED:

  DESCRIPTION OF BUSINESS

OWNERSHIP (CIRCLE ONE): CORPORATION PARTNERSHIP  PROPRIETERSHIP OTHER
DUN'S # DUN'S RATING:
FEDERAL ID # RESALE CERTIFICATE #
BONDING COMPANY NAME:
INSURANCE #
DO YOU REQUIRE A PURCHASE ORDER NUMBER?
DESCRIPTION OF BUSINESS ACTIVITY:

  NAMES & ADDRESSES OF CORPORATE OFFICERS OR OWNERS

1.
2.
3.
4.

  BANK INFORMATION

BANK NAME: BANK BRANCH:
ADDRESS:
ACCOUNT # CONTACT:
PHONE # FAX #