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Credit Application

The following information is to be used as a basis for consideration for extension of credit.

Name of Customer *
   Email *
Phone *
   Fax *
Street Address *
   City *
State/Province *
   Zip/Postal Code *
Mailing Address *
   City *
State/Province *
   Zip/Postal Code *
Related Firms *
Type of Business *
Year Established *
   Corporation   Partnership   Proprietorship  

Name of Principal Officers, Partners, or Proprietor, Accts. Payable Contact

Name *
   Title *
Name *
   Title *
Name
  Title

Bank Reference

Name of Bank *
City *
  
State/Province *
Zip/Postal Code *
Account Number
  Contact *
Phone *
  

Trade References (Give only names of those you purchase from an Open Account)

Name *
   Phone *
Address *
   City *
State/Province *
   Zip/Postal Code *
 
Name *
   Phone *
Address *
   City *
State/Province *
   Zip/Postal Code *
 
Name
  Phone
Address *
   City *
State/Province *
   Zip/Postal Code *

Financial Statement Highlights

Enter Financial Statement Details   Upload Financial Statement
Year Ending
Current Assets
Current Liabilities
Non Current Assets
Worth
Sales
Loans to Shareholders
Loans from Shareholders
The figures are present financial standing and business operations upon which you may rely for the purposes of establishing our credit.
Are you Tax Exempt *

Yes     No 		 
Certificate of Insurance upon Request *

Yes     No

Agree

The undersigned represents and warrants that the foregoing Confidential Information and the financial information is a true, correct and complete statement of the assets and the liabilities of undersigned as of the close of business on the
Full Name of Firm *
By *
   Title *
    EIN # *

There aren't any partners at present.

Phone: 888 ICEUSA1(423-8721)

Corporate Office
301 Warehouse Drive
Matthews, NC 28104 USA

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