CREDIT APPLICATION AND ACCOUNT AGREEMENTApplication and Account Agreement • September 22nd, 2015
Contract Type FiledSeptember 22nd, 2015CUSTOMER NAME (use full legal name) BILLING ADDRESS CITY STATE ZIP SHIP TO ADDRESS (if different) CITY STATE ZIP CONTACT NAME DEPARTMENT PHONE NUMBER CORPORATION PARTNERSHIP LIMITED PARTNERSHIP LLC SOLE PROPRIETOR NUMBER OF YEARS IN BUSINESS UNDER PRESENT MANAGEMENT FEDERAL ID. NO. SUBSIDIARY, DIVISION OR BRANCH OF PROPRIETOR, PARTNERS, OR OFFICERS NAME TITLE ADDRESS SSN (proprietor) NAME TITLE ADDRESS SSN (proprietor) NAME TITLE ADDRESS SSN (proprietor) TRADE REFERENCES (Please Provide Complete Address) NAME AND ADDRESS ACCOUNT NO. PHONE NAME AND ADDRESS ACCOUNT NO. PHONE NAME AND ADDRESS ACCOUNT NO. PHONE BANK INFORMATION BANK NAME AND ADDRESS PHONE BANK OFFICER ACCOUNT TYPEChecking Savings Loan ACCOUNT NO. LOAN INFORMATIONAmount Term Secured by TAX INFORMATION All Purchases Taxable Some Exempt All Exempt TAX EXEMPT CERT. NO. (attach copy)