Credit App

Best Screw Products Inc.

NEW ACCOUNT INFORMATION

Name
Title
Organization
Work Phone
Address
City
State/Province
Zip code/Postal code
Country
How Long At This Address	Years
Taxable	Yes, No
Tax Exemption #
Are Purchase Orders Required	Yes, No
Do You Accept Backorders	Yes, No
Real estate Owned	Yes, No
Mortgages
Do you pledge or Borrow Against Your Accounts Receivables	Yes, No
Do You Pledge or Borrow Against Your Inventory	Yes, No

TYPE OF OWNERSHIP
Partnership	Name of Partners & Address
Sole Ownership	Name of Owner & Address
Corporation	Name of Officers & Titles (Date and State of Incorporation)
Other	Explain

FINANCE
Bank	Account#
Phone
Address
City
State/Province
Zip code/Postal code
Country

TRADE REFERENCES
Name	1. 2.
Address	1. 2.
City	1. 2.
State/Province	1. 2.
Zip code/Postal code	1. 2.
Country	1. 2.
Phone	1. 2.

Name	3. 4.
Address	3. 4.
City	3. 4.
State/Province	3. 4.
Zip code/Postal code	3. 4.
Country	3. 4.
Phone	3. 4.

Application for credit is herby applied for and is to be used by your credit department only. We (I) hereby agree to your terms as stated and fully intend to abide by them. It is further understood that any deviation of said terms is strictly prohibited without the direct authorization of *Best Screw Products, Inc.* We understand that ownership of merchandise remains in the name of seller until paid in full
Name of Officer	Date:
Title of Officer