| Instructions: Please print this form and fill out the form
completely. |
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| Fax
the completed form to: Accounts Receivable/Credit and Collections Supervisor
Fax (336) 719-8183 |
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| RENFRO CORPORATION |
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| CREDIT APPLICATION |
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| Today's
Date : _______________________________ |
Line of Credit Requested $
____________________ |
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| Business
Name _____________________________ Phone (
)______-_______Fax (
)____-_______ |
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| Billing
Address ________________________________________________________E-mail
___________________ |
|
| Shipping
Address
_______________________________________________________________________________ |
|
|
| D/B/A :
_________________________________ FEDERAL TAX I.D. NUMBER
_______________________ |
|
| Former
Business Address (If Applicable)
_______________________________________________________ |
|
| Type of
Business__________________ Date Established________________ How long in
Business________ |
|
| Does
State, County or City Require a License? Yes |
|
No |
|
|
| If Yes,
License#
___________________________________________________________________________ |
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| OWNERSHIP: |
|
Sole Owner |
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|
Corporation |
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| PRINCIPAL:
______________________________________________________________________________ |
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|
(Name) |
(Title) |
(SS#) |
(Home Address) |
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| PRINCIPAL:
______________________________________________________________________________ |
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|
(Name) |
(Title) |
(SS#) |
(Home Address) |
|
|
| TRADE REFERENCES: |
|
(Name suppliers of major products
and services) |
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| NAME: |
|
PHONE NUMBER: |
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| _________________________________________ |
___________________________________________ |
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| _________________________________________ |
___________________________________________ |
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| _________________________________________ |
___________________________________________ |
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| _________________________________________ |
___________________________________________ |
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| _________________________________________ |
___________________________________________ |
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|
| BANK REFERENCE:
|
|
Checking |
|
Loan |
|
Savings |
|
| _______________________ |
________________________ |
_______________ |
________________ |
|
| _______________________ |
________________________ |
_______________ |
________________ |
|
| (Name) |
(Address) |
(Acct.#) |
(Contact) |
|
|
| No. of
Employees _________________ |
Est. Annual Sales $___________ |
Sales Area _____________ |
|
| Has
the firm or any of its Principals ever been bankrupt? Yes |
|
No |
|
|
| If yes,
Explain: __________________________________________________________________________________ |
|
|
| Accounts
Payable Contact Name and Phone #______________________________________________ |
|
| TERMS
ARE NET 30 DATE OF INVOICE |
|
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| Please
send all correspondence to: |
|
|
|
| Attn: Accounts
Receivable/Credit and Collections Supervisor |
|
| Renfro
Corporation / P.O. Box 908 /
661 Linville Rd. / Mt. Airy, N.C. 27030 |
|
| Phone
(336) 719-8725 / Fax (336) 719-8183 |
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