Please print out form, fill out, and fax it to (718) 963-9465.

330 Hendrickson Ave. Lynbrook, NY 11563
Tel: (718) 599-1500   Fax: (718) 963-9465


    
CREDIT APPLICATION
 

Company Name: ____________________________________________

Address: ________________________________  City: ________________  State: ____  Zip: _______

Phone: ______________________  Fax: ______________________

 

Bank Information

Bank Name: ________________________________________________

Phone: ______________________  Fax: ______________________

Account #: _________________________________

Contact: ___________________________________
 
Trade References
1. Company Name: ________________________________________________
    Address: ______________________________  City: ________________  State: ____  Zip: _______
    Phone: ______________________  Fax: ______________________
    Contact: _________________________________
 
2. Company Name: ________________________________________________
    Address: ______________________________  City: ________________  State: ____  Zip: _______
    Phone: ______________________  Fax: ______________________
    Contact: _________________________________
 
If seller deems it advisable to place collections of invoices in the hands of an attorney, purchaser shall pay attorney's fees of 20% of claims as well as cost, interests and disbursements. 1-1/2% interest per month charge on accounts over 30 days.
   
____________________________ ____________________________
Please Print Name Signature
   
____________________________ ____________________________
Title Date
   
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