AGREEMENT TO BE COMPLETED BY APPLICANTSpecial Delivery Instructions • February 4th, 2019
Contract Type FiledFebruary 4th, 2019TYPE OF BUSINESS CORPORATIONIndicate Officers Kind of Business SIC # D&B No # of Years This Business Under Current Ownership PARTNERSHIPIndicate Partners Other Locations Currently Owned Tax Exempt/Resale # (Attach copy of certificate) PROPRIETORSHIP Indicate Owner Line of Credit Requested Anticipated Monthly Purchase