Date:
Business Name:
Year Started:
Street Address
City
State Zip
Mailing
Address
Phone #
Federal Tax I.D #
Sales Tax #
E-Mail Address
Type of Business
Corporation
Yes
No If yes, please list:
Title
Name
Address
President
Vice President
Secretary
Treasurer
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Partnership
Yes
No Proprietorship
Yes
No
If yes, please list
all the owners/partners. (If you are located in AZ, CA, or TX, list the
spouses of the partners)
Name
Social Security #
Home
Address
Phone #
Name
Social Security #
Home
Address
Phone #
Name
Social Security #
Home
Address
Phone
|
| Bank References
Name
Acct. #
Address
Phone #
Name
Acct. #
Address
Phone #
|
| Trade
References Metal references
preferred
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
Name
Phone #
Address
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I/We herein make application
to Industrial Metal Supply for credit. The information contained
herein is true and complete in every respect. I/We hereby
authorize Industrial Metal Supply to verify all information provided and
to contact the individuals and companies referred to. Furthermore,
I/we hereby agree to pay all accounts and invoices in accordance with
the terms of sale shown on such invoices and statements. I/We also
agree to pay a 1-1/2% per month service charge on all balances and/or
amounts that are past due and further agree to pay any costs associated
with the collection of outstanding debt to Industrial Metal Supply
including, but not limited to, attorney's fees, court, or any
administrative costs deemed proper by the court.
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© 2007 Industrial Metal Supply Co.
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