Brochure

ACCOUNT/CREDIT APPLICATION
Date:
_________________
Business Name: Salesman:
Billing Address: Delivery Address:
Phone: Fax:
Email: Credit Requested (Estimated Monthly Purchases)
In Business Since: Type Of Business:
■ SOLE PROPRIETORSHIP ■ PARTNERSHIP ■ CORPORATION
Social Security Or Tax ID Number: D & B Number
*** PLEASE ATTACH A COPY OF YOUR STATE TAX EXEMPTION CERTIFICATE ***
*** PLEASE ATTACH A COPY OF YOUR CREDIT REFERENCES ***
It is understood in signing this document that the Applicant releases permission for credit information to be released by phone or letter by the references
attached. The signature below acts as releasing authority to the references approached for credit Information, as well as certifies that the information given
above is true and complete. The signature also certifies acceptance of the John Guest USA terms and conditions as outlined on the attached.
Print name of Owner/Officer/Authorized Individual Title:
Signature of Owner/Officer/Authorized Individual Date:
FOR OFFICE USE ONLY
Credit amount assigned: Approval:
Group: Industry Type:
JOHN GUEST USA, 180 PASSAIC AVENUE, FAIRFIELD, NJ 07004
Fax this sheet, along with tax exemption certificate and credit references, to 973-808-5036 for immediate processing.
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