Green Meadow Sales Lawnmower Parts

GREEN MEADOW SALES CORP CREDIT APPLICATION Page 2 of 2

Date

Line of Credit Desired

Firm Name
Phone

Shipping Address

Street
City
State
Zip

Billing Address

Street
City
State
Zip

Fed. Tax ID. #

Type of Business
Check one:
Corporation
Proprietorship
Partnership
Limited Partnership

Date Established

Names of Owners, Partners, or Officers

Name
Title
Residence Address
Home Phone
S.S.#

Name
Title
Residence Address
Home Phone
S.S.#

Name
Title
Residence Address
Home Phone
S.S.#


Bank Reference

Bank Name
Acct #
Street
City
State
Zip
Contact Phone

Credit References

Name
Acct #
Street
City
State
Zip
Contact Name
Contact Phone

Name
Acct #
Street
City
State
Zip
Contact Name
Contact Phone

Name
Acct #
Street
City
State
Zip
Contact Name
Contact Phone
Have any suits or judgements ever been taken against you? Check one: Yes No If yes, explain: Have you granted a security interest in your inventory to anyone? Check one: Yes No If yes, explain: Have you granted a security interest on your accounts receivable to anyone? Check one: Yes No If yes, explain: Are you subject to sales tax? Check one: Yes No If no, please fill out exemption certificate. Authorization to Release Credit Information I authorize the release of credit information on my account to Green Meadow Sales Corp. Dated this day of 2002 Authorized Signature Company Name Title Address