Credit Application Form

Bill To:

Name:

Address:

City: State: ZIP:

Phone:

Contact Name:

Ship To:

Address:

City: State: ZIP:

Receiving Hours:

Trade References:

Reference #1

Business Name:

Years with Business:

Fax:

Phone:

Reference #2

Business Name:

Years with Business:

Fax:

Phone:

Reference #3

Business Name:

Years with Business:

Fax:

Phone:

Reference #4

Business Name:

Years with Business:

Fax:

Phone:

It is agreed that we grant permission to contact these businesses in references for confidential credit information, with purpose of granting open account terms with Fibers of Kalamazoo, Inc.

Applicant's Digital Signature:

Date of Application: