601 Whitney Ave Ste #2 Lantana FL 33462
Phone: 561.444.2662
Fax: 561.444.2246
Credit Application Form
BUSINESS CONTACT INFORMATION
Title:
title is required.
Company Name:
company name is required.
Phone:
phone is required.
Fax:
Fax is required.
Email:
Registered company address:
City:
State:
Zip Code:
Date business commenced:
Sole proprietorship:
Partnership:
Corporation:
Other:
BUSINESS AND CREDIT INFORMATION
Primary business address:
City:
State:
Zip Code:
How long at current address?:
Telephone:
Fax:
Email:
Bank Name:
Bank Address:
Phone:
City:
State:
Zip Code:
Type of account:
Account number:
Savings:
Checking:
BUSINESS/TRADE REFERENCES
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
Type Of Account:
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
Type Of Account:
Company Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
Type Of Account:
AGREEMENT
All invoices are to be paid 15 days from the date of the invoice.
Claims arising from invoices must be made within seven working days.
By submitting this application, you authorize Nustar Building Materials LLC to make inquiries into the banking and business/trade references that youhave supplied.
SIGNATURES
Title
Title
Date
Date
