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COMPANY
PROFILE
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Company
Name:
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_________________________________________________________ |
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Doing
Business As:
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_________________________________________________________ |
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Address:
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_________________________________________________________ |
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_________________________________________________________ |
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_________________________________________________________ |
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City:
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_________________________________________________________ |
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State:
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________________________ |
Postal
Code:
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___________________ |
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Country:
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________________________ |
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Contact:
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________________________ |
Phone:
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___________________ |
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E-mail:
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________________________ |
Website:
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___________________ |
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Year
Established:
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________________________
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Business
Type:
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________________________ |
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#
of Branches:
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________________________ |
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#
of Salespeople:
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________________________ |
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OWNER
INFORMATION
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Name:
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_________________________________________________________ |
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Home
Address:
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_________________________________________________________ |
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_________________________________________________________ |
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City:
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_________________________________________________________ |
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State:
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________________________ |
Postal
Code:
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___________________ |
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Country:
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________________________ |
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Social
Security No:
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________________________ |
Home
Phone:
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___________________ |
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CREDIT
REFERENCES
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Reference
1:
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_________________________________________________________ |
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Address:
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_________________________________________________________ |
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_________________________________________________________ |
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Contact:
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________________________ |
Phone:
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___________________ |
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Credit
Limit:
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________________________ |
Fax:
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___________________ |
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Reference
2:
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_________________________________________________________ |
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Address:
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_________________________________________________________ |
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_________________________________________________________ |
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Contact:
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________________________ |
Phone:
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___________________ |
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Credit
Limit:
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________________________ |
Fax:
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___________________ |
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Reference
3:
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_________________________________________________________ |
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Address:
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_________________________________________________________ |
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_________________________________________________________ |
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Contact:
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________________________ |
Phone:
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___________________ |
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Credit
Limit:
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________________________ |
Fax:
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___________________ |
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PROPRIETOR
GUARANTEE
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signing this Application, I acknowledge that I have personally guaranteed
the debts and obligations of my business and agree that I am personally
obligated to perform all of the terms of, and make all payments
to Interactive Products Corp. required by the agreement of which
this Application is a part. I also authorize the listed credit references
to release any information regarding my credit history. |
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Authorized
Signature:
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________________________ |
Date:
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___________________ |
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| How
did you find us?
_________________________________________________ |
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Thanks,
and we look forward to doing business with you!
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