cs@abchomestore.com
CREDIT APPLICATION
Company Name:________________________ Parent Company: ________________________
Billing Address:_________________________ City:_________ ____ State: ____ Zip:_______
Accounts Payable Contact: ____________________________________________________
Phone No.:(___)___________ Fax No.: (___)___________ Federal ID No.: ______________
□
Corporation □ Partnership □ Individual Year Incorporated: __________________BANK REFERENCE
Bank Name: _________________________________________________________________
Bank Address: _________________________ City:_________ ____ State: ____ Zip:_______
Bank Contact: _________________________________________________________________
Phone No.: (___)________________ Account No.: ___________________________
CREDIT REFERENCES MUST HAVE TWO (3)
1st Company Name: __________________________________________________________
Address: _________________________ City:_________ ____ State: ____ Zip:_______
Phone No.: (___)________________ Account No.: ___________________________
2nd Company Name: __________________________________________________________
Address: _________________________ City:_________ ____ State: ____ Zip:_______
Phone No.: (___)________________ Account No.: ___________________________
3nd Company Name: __________________________________________________________
Address: _________________________ City:_________ ____ State: ____ Zip:_______
Phone No.: (___)________________ Account No.: ___________________________
______________________________________________________________________________
Authorization for bank and vendor release of information:
Signature: _______________________________ Title: __________________________
SUBJECT TO TERMS AND CONDITIONS ON OUR THE ABC HOME STORE.COM WEB SITE
FOR OFFICE USE ONLY:
Office Code:_________ Level: _________ Account No.: _________ Approved by: ___________
Date: ____/____/____ Credit limit: $______________ Salesperson:
PLEASE COMPLETE ENTIRE FORM AND FAX BACK TO: 718.456-3707