Credit Application Form | A1 Servomotor Repair

Credit Application

Company Name

Date

Address

Phone

Fax

Business Structure:

Corporation

Division Subsidiary

Partnership

Owner

Federal ID Number

Number of Years in Business

Dun & Bradstreet Number

Product Line

Bank Reference:

Name

Account No.

Address

Officer

Trade References (please provide 3):

Name

Account No.

Address

Fax Number

Name

Account No.

Address

Fax Number

Name

Account No.

Address

Fax Number

I hereby certify that the information in this credit application is correct. The information included in the credit application is for use by A-1 Servomotor Repair in determining the amount and conditions of credit to be extended. Further, I hereby authorize the bank and trade references listed in this credit application to release the information necessary to assist A-1 Servomotor Repair in establishing a line of credit for my company.

Your Signature

Title

A-1 Servomotor Repair

Serving Automated Industries Since 1982

Credit Application

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