Carneval's

INTERSTATE SECURITY Inc.

2310 State Street - Erie, PA 16503

814.459.0546 (Local)  

800.543.8837 (Toll Free)  

814.456.1542 (FAX)  

 

CREDIT APPLICATION

 

Company Name  __________________________________________________  Years In Business? ___________________

Address _________________________________________________________   Fax Phone (         ) ___________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) __________________

 [    ] Proprietorship [    ] Partnership [    ] Corporation    Federal ID# ______________ Tax Exempt ID# ________________

 List name, home address and telephone number of principal owner(s)/officer(s).

 Name  __________________________________________________________

Address _________________________________________________________   Social Security #     __________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) __________________

 Name  __________________________________________________________

Address _________________________________________________________   Social Security #     __________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) __________________

 Bank

Name  __________________________________________________________

Address _________________________________________________________  Fax Phone (         ) __________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) _________________

Checking Account # __________________________  Savings/Line Of Credit Account # ____________________________

 Suppliers

Name  __________________________________________________________

Address _________________________________________________________  Fax Phone (         ) __________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) _________________

 Name  __________________________________________________________

Address _________________________________________________________  Fax Phone (         ) __________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) _________________

 Name  __________________________________________________________

Address _________________________________________________________  Fax Phone (         ) __________________

City _______________________________ State _______ Zip _______________ Telephone  (         ) _________________

 The undersigned understand(s) that the above information is given for the purpose of obtaining credit and authorizes the        investigation of this information.  I (We) certify that I am (we are) one of the above named principals or officers, that the above   statements are true and complete, and that I (we) personally guarantee payment for all goods ordered by the above company from Interstate Security, Inc.

Signed __________________________________________  Date  __________________________

Signed __________________________________________  Date  __________________________

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