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Needlecraft, Inc. Credit Application
Business Name:
Other Business Name:
Business Address:
City:
State:
Zip:
Contact:
Telephone #:
Fax #:
Federal ID#:
e-mail:
Type of Business:
Date Started:
Annual Sales:
# Employees:
CHECK TYPE OF ORGANIZATION
SOLE PROPRIETORSHIP
(give legal name of Proprietor, residence address, residence telephone #, Social Security #)
PARTNERSHIP
(give the full names, addresses, phone #, and Social Security # of all partners)
CORPORATION
(give names, addresses and telephone #, and Social Security # of officers)
1
Name & Title
Residential Address
City
State
Zip
Telephone
Social Security #
2
Name & Title
Residential Address
City
State
Zip
Telephone
Social Security #
3
Name & Title
Residential Address
City
State
Zip
Telephone
Social Security #
BANK REFERENCE
Name:
Contact:
Phone:
Street:
City:
State:
Zip:
TRADE CREDIT REFERENCES
1
Name
City
State
Zip
Phone #
Fax #
2
Name
City
State
Zip
Phone #
Fax #
3
Name
City
State
Zip
Phone #
Fax #
I/We hereby authorize you or any credit reporting agency employed by you to investigate the references herein listed or to investigate my/our personal credit and financial records including my/our banking records. I/We hereby certify that I/we have read this form thoroughly and accept its conditions. I/ We further state that all information supplied by me/us is true in fact and intent.
Please select this check box if you have read and agree to the above terms
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