South Mill Credit Application


CREDIT APPLICATION 649 West South Street ٠ P.O. Box 1037 ٠ Kennett Square, Pa. 19348 ٠ Tel: 610-444-4800 ٠ Fax: 610-444-1338
A.	Legal Name
	Trade Name (s)
	Bill to Address
	Ship to Address

	City		State		Zip
	Telephone		Fax		E-Mail
	Federal Tax ID		D&B #		PACA #

CORPORATION

PROPRIETORSHIP

PARTNERSHIP

YRS. IN BUSINESS

# OF EMPLOYEES


B.	NAMES OF PRINCIPAL OFFICERS, PARTNERS, OR OWNERS:

	Name	S.S.N.	Title
	Name	S.S.N.	Title
	Name	S.S.N.	Title


C.	Persons to Contact:

	Name	Telephone	D.O.B.
	Name	Telephone	D.O.B.
	Name	Telephone	D.O.B.


D.	PLEASE LIST ANY RELATED COMPANIES IN WHICH THE PRINCIPALS HAVE AN INTEREST.

	Name	Address
	Name	Address


E.	ARE YOUR RECEIVABLES AND/OR INVENTORY PLEDGED TO OTHERS?

	NO	YES	If Yes, Please Explain:


F.	WE ESTIMATE OUR ANNUAL PURCHASES AT	$
	VOLUME OF BUSINESS LAST YEAR	$
	WE REQUEST A CREDIT LINE OF	$

G.	NAME AREA (S) YOU SERVICE


H.	TRADE REFERENCES: Complete address & fax # is necessary to process your application promptly)

	1. Name		Contact Person
	Address		Credit Limit
	Telephone #		Fax #
	2. Name		Contact Person
	Address		Credit Limit
	Telephone #		Fax #
	3. Name		Contact Person
	Address		Credit Limit
	Telephone #		Fax #
	4. Name		Contact Person
	Address		Credit Limit
	Telephone #		Fax #


I.	BANK REFERENCES:

	Bank Name		Address
	Type		Acct #
	Type		Acct #
	Type		Acct #

J.	I certify that all material purchased are for resale. There will be a fee charged for any returned checks
	received. In the event that legal action shall become necessary in order to effect collection for the
	merchandise purchased from South Mill, I agree to pay all collection costs including reasonable
	attorney fees.

Signed

Date

Name & Title