Note:
*
= required information
BY:
Name of firm or individual
*
Address
Years at this address
City
State
Zip
Area code
Phone
Fax Area Code
Fax Phone Number:
HEREBY applies for credit in accordance with the terms and conditions of:
TO:
Rochester Insulated Glass, Inc.
P.O. Box 168
73 Merrick Circle
Manchester, NY 14504
Credit manager
Michelle Jerome
Our normal credit terms
2 % 10 Net 30
The following information must be provided. It will be held in the strictest confidence.
OWNERSHIP:
Corporation
Check here if incorporated within the past 12 months
Partnership
Individual
Name(s) of principals
Complete address
Zip
Phone
1.
2.
3.
4.
FINANCE:
Bank
Bank address
Bank officer or department
Phone
REFERENCES:
Business name
Complete address
Zip
Phone
1.
2.
3.
4.
Check here if cash sales are okay until credit is approved
We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.
*
Initials:
*
Date:
1/6/2009
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