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Credit Application
Date:
Company Name
Corporation
Address
Sole Proprietor
City
State
Zip
Other (specify)
Telephone
Fax
Contact for Credit Information (Name & Title)
Email
Taxable
Non Taxable (Please include Form ST-3 Resale Certificate)
Bank References:-
Name
Address
City
State
Telephone
Fax
Contact
Title
Trade References
Name
Address
City
State
Contact
Title
Name
Address
City
State
Contact
Title
Name
Address
City
State
Contact
Title
I authorize the above named bank to furnish pertinent credit information to the Bilco Group
Signature
Title
