Thank you for applying for credit with Seven D Industries. Please complete this application and hit send when finished. By sending this application it will
serve as permission for Seven D Industries to verify all information, and obtain information by securing data from credit reporting agency(ies).

In order to induce Seven D Industries to extend credit to the applicant, the applicant warrants that the information given herein is correct and material to the granting of credit, and grees to advise Seven D Industries, in writing, of any changes in any information set forth herein or furnished herewith.

The warranties, covenants, and conditions contained herein are continuing in nature and shall remain as long as the applicant is indebted to or seeks credit from Seven D Industries.

 

Trading Name: Phone:

Legal Name:

Address: City: State: ZipCode:

Date Established: Year Incorporated: If subsidiary, list parent company:

Tax Exemption # Check one: Corpration Individual Gen Partnership Ltd Partnership

Principal Owners / StockHolders

Name: Address: Phone:

Name: Address: Phone:

Name: Address: Phone:

Name: Address: Phone:

Suppliers / Main Vendors

Name: Address: Phone:

Name: Address: Phone:

Name: Address: Phone:

Bank / Financial Institution

Name: Address: Account:

Name: Address: Account:

Name: Address: Account:

 

Names authorized to charge to account:

Credit amount requested : Date:

By submitting this document you are stating that all information is correct and that you have read and agreed with the discourse above.

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