CREDIT APPLICATION
4530 Hamann Pkwy, Unit B
Willoughby, OH 44094
(330) 963-6500
www.genfitllc.com
Company Name:
Billing Address:
Shipping Address:
City, State, Zip:
City, State, Zip:
Telephone:
Fax Number:
Type of Organization
Corporation
Partnership
Sole Prop.
Federal Tax Number:
Type of Business:
Date Established:
Full Name of Owner, Owners, and Corporate Officers:
Debtor: (Indiv Sign App)
Title:
Debtor Social Security: (For Partnership and Sole Prop)
Purchasing Agent Name:
Purchasing Agent Phone:
Purchasing email:
Do you prefer to receive order confirmation via: (Please circle preferred method)
E - mail Account: (Include Address)
Fax: (Number)
Standard Mail: (Address / P.O Box)
Do you prefer to receive order confirmation via: (Please circle preferred method)
E - mail Account: (Include Address)
Fax: (Number)
Standard Mail: (Address / P.O Box)
Please Include With This Completed Form 3 Trade References and 1 Bank Reference
Reference #1
Reference #2
Reference #3
Bank Reference
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