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Thorpe Electric Supply, Inc. Credit Application
Name / Address
First name
Last name
Email
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
Code
Phone
Social Security #
Date of Birth
Company Information
Business Name
Tax I.D. #
Address
Phone:
Type of Business
Corporation
Partnership
Proprietorship
If Division / Subsidiary, Name of Parent Company
Address
Fax:
In Business Since
No
Yes - If so, please provide copy of Exempt Certiicate
Tax Exempt:
In Business Since
Phone
Name and Title of Company Principle Responsible for Business Transactions
Address
Phone
Bank References
Institution Name
Institution Name
Institution Name
Checking Account #
Savings Account #
H E Loan / LOC
Loan Balance
Address
Address
Address
Phone
Phone
Phone
Trade References
Company Name
Company Name
Company Name
Contact Name / Address / Phone # / Email
Contact Name / Address / Phone # / Email
Contact Name / Address / Phone # / Email
Credit Limit
Credit Limit
Credit Limit
Current Balance
Current Balance
Current Balance
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understadning that it is to be used to determine the amount and conditions of any credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to Thorpe Electric Supply, Inc. for which credit is being applied for and to verify the information contained herein.
Signature / Title
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Date
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