Credit Application

West Campus

402 Millstone Dr.

Hillsborough, NC 27278

Email: info@stevenmarsilisales.com

Tel:  (888) 360-9784  Fax:(888)314-1393

APPLICANT DATA

Name of Company_____________________________________________________________________

Address______________________________________________________________________________

City/State/Zip_________________________________________________________________________

Contact at Company__________________________________ Phone: (           )_____________________

Type of Business_____________________________________    Fax: (           )____________________

Date Established_____________Annual Sales Volume_______________Resale #___________________

 

BILLING ADDRESS (If Different From Above)

Name of Company_____________________________________________________________________

Address______________________________________________________________________________

City/State/Zip_________________________________________________________________________

 

IMPORTANT - IN ORDER FOR YOUR CREDIT APPLICATION TO BE PROCESSED ALL AREAS BELOW MUST BE FILLED IN COMPLETELY.  FAX NUMBERS MUST BE PROVIDED.

BANK REFERENCE

Name_________________________________Address____________________________________

City__________________________________          State______________________________________

Phone (         )__________________________          Contact____________________________________

Account Number________________________           Loan Account Number________________________

 

BUSINESS CREDIT REFERENCES

Name_________________________________Address____________________________________

City__________________________________          State______________________________________

Phone (         )__________________________          Contact____________________________________

Account Number________________________           Fax (         )_______________________________

 

Name_________________________________Address____________________________________

City__________________________________          State______________________________________

Phone (         )__________________________          Contact____________________________________

Account Number________________________           Fax (         )_______________________________

 

Name_________________________________Address____________________________________

City__________________________________          State______________________________________

Phone (         )__________________________          Contact____________________________________

Account Number________________________           Fax (         )_______________________________

 

The undersigned, as representative of the above company, guarantees payment by the company within (30) days of any indebtedness by any employee of said company.

 

____________________________________________________        ____________________________________________

Signature of Officer                                            Date                                                        Title