New Customer Credit Application

Credit Application And Agreement

Company name

DBA

Years in business

Phone

Fax

Company Email

Mailing address

(Address, City, State, Zip)

Shipping address

(Address, City, State, Zip)

Primary line of business

Line of credit requested

Type of business

Individual

Partnership

Corporation

Subsidiary

Owner's Name

(Major Shareholders, Directors, and Officers)

Incorporated in what state

Credit References (Must List Three)

Company Name

Contact

Phone

Fax

Address

(Address, City, State, Zip)

Company Name

Contact

Phone

Fax

Address

(Address, City, State, Zip)

Company Name

Contact

Phone

Fax

Address

(Address, City, State, Zip)

Bank Reference

(Cannot process without account number and signature)

Name

Branch

Account Number

Address

(Address, City, State, Zip)

Dun & Bradstreet

Yes

Listed Under

Year

1. The above information is true and is given for the purpose of obtaining an open credit line with Briteline Extrusions, Inc

2. I agree to abide by the payment terms to be established by Briteline Extrusions

3. I understand that no return merchandise will be accepted unless authorized in advance in writing

Name

Title

Signature

Type your name to sign the application

Thank you for your cooperation.

Please call us if you have any additional questions or comments

Credit Application And Agreement

Credit References (Must List Three)

Bank Reference

Briteline Extrusions

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