Address______________________City__________State_________Zip_____
Owner/Manager_______________________________Tel.No.______________
How long in business________________________D B Rated__________
Trade References：
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Bank References：
Name_______________________________Address_______________________
Name_______________________________Address_______________________
Credit line requested $_________________________________
Pending1 lawsuits2 against Company：
___________________________________________________
___________________________________________________
___________________________________________________
The undersigned authorizes3 inquiry4 as to credit information. We further acknowledge that credit privileges， if granted， may be withdrawn5 at any time.
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