Date:_____________Barbara Esposito
Accounts Receivable Manager
Date:_____________
Barbara Esposito
Accounts
Receivable Manager
Credit Application
Please print and complete the following and fax back to 860-378-0113
Corporate Information:
Name:_____________________________________________________
Company: __________________________________________________
Address:___________________________________________________
Address:___________________________________________________
City:__________________________State:______Zip Code:___________
Phone:_______________________Fax:___________________________
How long in business:__________________________________________
__________________________________________________________________________________
Reference:
1. Company:________________________________________________
Address:_________________________________________________
Phone:_______________________Fax:________________________
2. Company:________________________________________________
Address:_________________________________________________
Phone:_______________________Fax:________________________
3. Company:________________________________________________
Address:_________________________________________________
Phone:_______________________Fax:_________________________
__________________________________________________________________________________
Federal Tax ID:
Sales Tax:
( )
Proprietorship
( )
Partnership
( ) Corporation
Bank:
Account Number:
Contact:
Phone:
Fax:
Officers:
Position:
Signature:
TOMMY TAPE INC. P.O.Box 864 Southington, CT 06489 Tel: 860-378-0111 Fax: 860-378-0113 www.tommytape.com