ENVIRONMENTAL MATERIALS INC
CREDIT
Company
Company
Company
Company
Billing
City:
Type of
Federal
INFORMATION
REQUEST
FORM
Name:
Contact:
Phone Number:
Fax Number:
Address:
Business:
1D:
Names of Principal
State:
ZIP:
Partnership
LLC
Social Security #
Corp
Officers,
Bank Information:
Bank Name:
Address:
City:
Bank Contact:
Partners
Title:
Sole Prop
or Owners:
Social Security
Account
#
#
ZIP:
State:
Phone Number:
Trade References:
1 Company Name:
Address:
City /State/Zip
Phone #:
Contact:
Fax #:
2 Company Name:
Address:
City /State/Zip
Phone # :
Contact:
Fax # :
Contact:
3 Company Name:
Address:
City/State/Zip
Phone # :
Fax # :
The information in this application and in all financial statements submitted in connection herewith is for the purpose of
obtaining credit and is represented by the applicant to be true and complete.
credit
trade
references
creditors
and any other
to submit
matters
complete
pertaining
information
to its financial
for the purpose
Company:
Signed by:
Our payment terms are Net 30 unless
The applicant authorizes
responsibility.
The undersigned
of c~edit evaluation.
otherwise
Date:
Title:
agreed upon in writing
you to investigate all
authorizes
its bank and