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 #     
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