Marfred Industries, Inc. Corporate Offices and Distribution Center 12708 Branford Street ¨ Sun Valley, CA 91353 (818) 896-0550 * (323) 875-3184 * (714) 739-5734 * (800) 529-5156 FAX (818) 890-9532

Customer #:

Rev 03/01

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STANDARD CREDIT APPLICATION: - Please fill out form completely -

Date:

Salesperson:

CUSTOMER NAME:				("Customer")
Billing Address:
Delivery Address:
City/State/Zip Code:
Contact Person:		Title:

Please Check one:

Individual

Partnership

Corporation

Govt.

In business since:

State/Date Incorporated

# of employees

Type of business or Service:

Website

Phone #:

Fax#

Email

PRINCIPALS:
Name:		Title:
Name:		Title:
Name:		Title:

CREDIT REFERENCES:
Name		Address	Phone	Fax
1.
2.
3.

BANK:
Name		Address	Phone	Account #
1.
2.

AUTHORIZATION:
I hereby grant permission to above named banking institution to release information to Marfred Industries.
 

Credit line desired $   Would financial information be available upon request? Please read Marfred Industries' Standard Credit Application Terms and Conditions.) By virtue of my signature I hereby acknowledge the Terms and Conditions. By: Title: Date:     (Customer's Authorized Representative)

PLEASE BE ASSURED:   All information provided would be held in the strictes confidence.   THANK YOU!