Sutton

CONFIDENTIAL CREDIT APPLICATION:

Company Name:	Cu#:

Bill to Address:

City:	State:	Zip:

Phone:	Fax:

A/P Contact name:	Email address:

Ship to address :

City:	State:	Zip:

Shipper:	Account #	Color:

Sales Contact:	Phone:	Email Address:

Type of Entity:

Corp:	LLC:	Partnership:	Proprietorship:

Fein#:	Sales Tax No:
	“ For FL. State, send copy of Certificate”

Type of Business:	Yrs.in Bus.:	Avg.mthly sales:

RESPONSIBLE PARTIES (Owners,Partners, Officers)

	NAME	TITLE	HOME ADDRESS	HOME PHONE	SS NUMBER
1
2
3

By signing below, I authorize Sutton Ferneries, Inc to release any information requested and contact all references and persons listed below, also to investigate my personal credit history, including accessing credit bureau reports for purposes of making credit decisions. It is understood that all information will be confidential.

Name:

Signature:

Name of your Bank:	Phone:

Address:	Acct.#:

Contact Person:

Authorized Signature for bank account:

Trade references (Companies presently extending credit)

Reference 1:

Name:	Contact:	Phone:

Address:	Fax:

Reference 2:

Name:	Contact:	Phone:

Address:	Fax:

Reference 3:

Name:	Contact:	Phone:

Address:	Fax:

I ACCEPT THE CONDITIONS OF THE RECORD - CREDIT APPLICATION

Print and send by fax to 305-477-4030