WMJ MARINE - CREDIT APPLICATION

 

Business Background  
Name: How many years in business?
Street Address: Federal Tax ID#:
City, State, Zip code: Ownership:

__ Sole Owner          __  Partnership          __ Corporation
Country: Principal Name:

 

Phone: Buy's Name:

 

Fax: Accounts Payables:

 

E-mail:

 

 

Trade References

#1 Reference

Company Name

Address:

 

Phone:

Fax:

Account #:

 

#2 Reference

Company Name

Address:

 

Phone:

Fax:

Account #:

 

#3 Reference

Company Name

Address:

 

Phone:

Fax:

Account #:

Bank Reference

Bank Name

Address:

 

_ Checking      __ Saving

Phone:

Fax:

Account #:

 Has the firm or any of its Principals
ever filed bankruptcy?


__ Yes     __ No

I hereby authorize my bank _______________  to release any information needed on account #  ______________ to WMJ Marine.

___________________________________  Signature                  ____________________  Date

___________________________________  Print Name

___________________________________  Signature                  ____________________  Date

___________________________________  Print Name

 

PLEASE COMPLETE THIS FORM AND FAX THIS APPLICATION TO 501 631 4759

ATTN:   CREDIT APPLICATION

WMJ MARINE