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Feder's Company 5725 Lankershim Blvd. Toll Free: 888-353-8444 |
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| *Please
print this form and then fill it out, then fax it to us! We must have
a signature* |
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Feder's Company 5725 Lankershim Blvd. Toll Free: 888-353-8444 |
|
||||
| |
|
||||
| *Please
print this form and then fill it out, then fax it to us! We must have
a signature* |
|||||
| BUSINESS NAME______________________________________________________________________ STREET ADDRESS ___________________________________________________________________ P.O. BOX ______ P.O. BOX ZIP ______ EMAIL _____________ WEBSITE ADDRESS______________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ TYPE OF BUSINESS _____________________________ DATE ESTABLISHED ________________ |
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| OWNERSHIP - CHECK ONE BELOW |
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| THIS BUSINESS IS A CORPORATION (IF CHECKED, GIVE NAMES OF CORPORATE OFFICERS) | |
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NAME _______________________ TITLE ________________________________ NAME _______________________ TITLE ________________________________ FED ID#______________________ |
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| THIS BUSINESS IS A SOLE PROPRIETORSHIP (IF CHECKED, FILL OUT THE INFORMATION BELOW) | |
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OWNERS NAME __________________________ SSN _____________________________ STREET ADDRESS ____________________________________________________________ CITY ______________ STATE _________ ZIP __________ PHONE# _______________ |
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| THIS BUSINESS IS A PARTNERSHIP (IF CHECKED, FILL OUT THE INFORMATION BELOW) | |
| PARTNERS NAME _________________________ SSN _______________________________ STREET ADDRESS _____________________________________________________________ CITY ______________ STATE _________ ZIP __________ PHONE# _______________ |
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| PARTNERS NAME _________________________ SSN _______________________________ STREET ADDRESS _____________________________________________________________ CITY ______________ STATE _________ ZIP _________ PHONE# ________________ |
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| IF BILLS ARE PAID BY A PARENT COMPANY, FILL IN THE INFORMATION BELOW |
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| PARENT COMPANY______________________________________________________________ STREET ADDRESS ______________________________________________________________ CITY______________ STATE ___________ ZIP__________ PHONE# _________________ |
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| BANK REFERENCES |
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| SAVINGS NAME _______________________ ACCT# ____________________________ CHECKING BRANCH ________________________ LOAN STREET ADDRESS _____________________________ CITY ______________ STATE ___________ ZIP _________ PHONE# _________________ |
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| SAVINGS NAME _______________________ ACCT# ____________________________ CHECKING BRANCH ________________________ LOAN STREET ADDRESS _____________________________ CITY ______________ STATE ___________ ZIP _________ PHONE# _________________ |
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| COMMERCIAL TRADE REFERENCES: GIVE ONLY NAMES OF THOSE YOU BUY FROM ON OPEN ACCOUNT. REFERENCES WILL NOT BE CONSIDERED VALID UNLESS FULL NAMES AND ADDRESSES ARE INCLUDED. PLEASE LIST A MINIMUM OF THREE. | |
| 1. NAME __________________________________ STREET ADDRESS __________________________________ CITY _____________ STATE ____________ ZIP _________ PHONE# _________________ |
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| 2. NAME __________________________________ STREET ADDRESS __________________________________ CITY _____________ STATE ____________ ZIP _________ PHONE# _________________ |
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| 3. NAME __________________________________ STREET ADDRESS __________________________________ CITY _____________ STATE ____________ ZIP _________ PHONE# _________________ |
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| 4. NAME __________________________________ STREET ADDRESS __________________________________ CITY _____________ STATE ____________ ZIP _________ PHONE# _________________ |
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| click here for PERSONAL GUARANTEE (WE MUST HAVE IF CORPORATION) |
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| Required Authorization Signature Below |
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| AMOUNT OF CREDIT DESIRED MONTHLY $______________________ | |
| RESALE PERMIT #________________ CLICK HERE TO FILL OUT RESALE FORM | |
| PURCHASE ORDER REQUIRED? YES NO | |
| BILLING INSTRUCTIONS ____________________________________________________________ | |
| SHOULD FEDERS COMPANY APPROVE THIS APPLICATION, I/WE AGREE TO PAY FOR GOODS PURCHASED WITHIN 30 (THIRTY) DAYS OF INVOICE DATE. FEDERS COMPANY IS AUTHORIZED TO CONTACT ANY REFERENCES OR BANKS LISTED ABOVE. IT IS UNDERSTOOD THAT ANY INFORMATION OBTAINED WILL BE USED SOLELY FOR GRANTING CREDIT. SERVICE CHARGES AT THE HIGHEST RATE PERMITTED BY STATE LAW WILL BE APPLIED TO PAST DUE ACCOUNTS. SHOULD IT BECOME NECESSARY TO COLLECT THIS ACCOUNT THROUGH AN ATTORNEY, LEGAL PROCEEDINGS, OR OTHERWISE, THE UNDERSIGNED, INCLUDING ENDORSERS, PROMISE TO PAY ALL COSTS OF COLLECTION, INCLUDING REASONABLE ATTORNEYS FEES. | |
| BUSINESS NAME ___________________________________________________________________ STREET ADDRESS ___________________________________________________________________ P.O. BOX ______ P.O. BOX ZIP ______ EMAIL ___________________ URL________________ CITY __________ STATE ____ ZIP _______ PHONE# ________________ FAX# ___________ |
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| DATE _______________
TITLE _______________ |
SIGNATURE _____________________________ AUTHORIZED BUYER/ CO. OFFICER/ PARTNER |