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-COMMERCIAL CREDIT APPLICATION-

Account Name:_________________________________________________________________________

Address:__________________________________City & Zip Code:______________________________

Mailing Address:_______________________________________________________________________

Phone Number:______________________________Fax Number:________________________________

For Corporation:

(A) Date Incorporated:_________________ President:__________________________________

Vice Pres:__________________________________

(B) Name of Parent Co:___________________________________________________________________________

For Partnerships and Sole Proprietorships:

(A) Date-Start of Business:_____________________

(B) Owners Name:____________________________ SS#:_______________________________

Owners Name:____________________________ SS#:_______________________________

Credit References:

Name Address Phone Number

1.____________________________________________________________________________________

2._____________________________________________________________________________________________

3._____________________________________________________________________________________________

4._____________________________________________________________________________________________

P.O. Required?_____yes_____no Resale?_____yes_____no (If yes, include Resale Card)

Please list those persons authorized by your company to sign for purchases:_____________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Have you ever applied for credit with MARSHALL’S INDUSTRIAL HARDWARE LLC under this name or another name? If yes, under what name?___________________________________________________

****PLEASE FILL OUT BOTH SIDES****