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No one offers a more complete selection and ships from more locations across the nation.
Company Name
  Corporation  Sole Proprietor  LLC  Partnership  Trust
President Vice President
Treasurer Clerk
Billing Address
Shipping Address
City, State, Zip
Website              Email Accounts Payable
Contact Person Accounts Payable
Phone Number Accounts Payable
General Phone Number           Fax Number  
Years in Business           Number of Locations  
Credit Ref. #1    Phone    Fax
Credit Ref. #2    Phone    Fax
Bank Name    Phone    Fax
Bank Acct. No.
City, ST, Zip

On behalf of the above listed company I hereby authorize Eastern States Packaging, Inc. and
its representatives to be given financial information for the purpose of evaluating credit worthiness.
This information is private and not to be distributed or disclosed in any way.
Date     Name Authorized Person     Title


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