APPLICATION FOR CORPORATE CREDIT ACCOUNT Part 1
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___________________________________________________    __________________________________
NAME OF CORPORATE ACCOUNT                                                                         DATE 
_________________________________________________________________________________ 
ADDRESS:      NUMBER     STREET                   APT/SUITE          CITY                   STATE            ZIP CODE 
FEDERAL TAX ID NUMBER/ SOCIAL SECURITY NUMBER: ___________________________ ___________________________ 
                                                                                                                                       STATE OF CORPORATION 
TELEPHONE NUMBER(S) _____________________________________ FAX NUMBER___________________________ 
                                         CORPORATE OFFICERS:  
        
PRESIDENT: ____________________________________________________________________ 
         VICE PRESIDENT: _______________________________________________________________
         CONTROLLER: ___________________________________________________________________ 
         OTHER: _________________________________________________________________________
CORPORATE CREDIT CARD: _______________________________________________________________________________
                                             Name on Card                             Credit Card Number                  Exp. Date

 

       BILLING PREFERENCE:    (  ) Credit Card Billing               (  ) Monthly Direct Billing 

Bank References:

__________________________________________________________________________________
Name                                   Branch & Telephone Number              Account Number             Contact Person 
__________________________________________________________________________________
Name                                   Branch & Telephone Number              Account Number             Contact Person 

Credit References:
 
Credit Cards: List credit card, account number, expiration date, telephone and billing address 
Creditors & Vendors: List name of company, account number, telephone and billing address 
__________________________________________________________________________________
Name                                           Account Number                      Telephone                      Billing Address 
__________________________________________________________________________________
Name                                           Account Number                      Telephone                      Billing Address 
__________________________________________________________________________________
Name                                           Account Number                      Telephone                      Billing Address 

 

Go to Credit Account Application Part 2