1711 Callens Rd. ~ Ventura, Ca. 93003 ~ (805) 656-0715 ~ fax (805) 644-1695
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"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.3
CUSTOMER AUTHORIZATION TO RELEASE ACCOUNT
INFORMATION
*****(REQUIRED!!)*****
In many instances the bank requires a signature from a person who is authorized for this bank account in order for us to obtain any information concerning the account. To expedite your credit with us, please complete the following:
| YOUR BANK: | |
| ADDRESS: | |
| ACCOUNT # | FAX # |
| I, (AUTHORIZED PERSONS' NAME HERE): | |
| , DO HEREBY AUTHORIZE (NAME OF BANK HERE): | |
| TO RELEASE INFORMATION CONCERNING OUR ACCOUNT TO: (see below) | |
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B & R SUPPLY, INC. |
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| SIGNATURE: | DATE: |
| NAME OF COMPANY: | ||||||||||
| ACCOUNT # | ||||||||||
| The above named company has applied to us for credit and given you as their bank. Kindly fill-in this form and return it to us. Use the enclosed stamped self-addressed envelope or fax it to us: (805) 644-1695. Thank you so much for your help! | ||||||||||
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