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CREDIT APPLICATION

Company Name

Corporation Sole Proprietor LLC Partnership Trust

President

Vice President

Treasurer

Clerk

	Billing Address	Shipping Address
Address
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.

Address

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