STONE & BERG CREDIT APPLICATION
Confidential: For Credit Department Use
Please answer all questions
Stone & Berg (508)753-3551 (Local)
Wholesale Locksmith Supply Company(800) 225-7405 (National)
239 Mill Street, Worcester, MA 01602 (800) 535-5625 (Fax)
(Application approved by Controller______________)  (Application approved by GM______________)
Above is for Stone & Berg's office(s) use only
The following information must be completed in full, and will be used in connection with Stone& Berg's decision to grant or deny credit.
Credit amount requested: Date of application:
  1. Account (Legal) Name: ("Customer")
         Trade Name: ("Customer")
  2. Shipping Address:
                                       Street                                City                             State            Zip Code
  3. Mailing Address:
                                     Street                                City                             State            Zip Code
  4. Telephone Number:     Fax Number:
    E-Mail:    Web Address:
  5. Federal I.D. Number:     S.S. Number:
    DUNS Number:
  6. Business Type:    State/Province:
  7. Years in Business:     Years Incorporated:
  8. Have you ever filed for bankruptcy? YesNo
  9. Type of Location:   Other?
  10. Tax Exemption Number: Massachusetts Businesses, send copy of Mass Sales Tax Resale Certificate Form ST-4
  11. Is this business affiliated with or part of another business that is now a customer? YesNo

    12. If so, give details

    If partnership or sole proprietorship, identify all principals using additional sheets if necessary. If a corporation, identify the President, Treasurer and Secretary and note titles accordingly.

  1. Principals/Corporate Officers:

    Principal's name:     Title:
    Home Address:  
    OwnRent    Property in name of:     Phone #:



    Principal's name: Title:
    Home Address:  
    OwnRent    Property in name of:     Phone #:



    Principal's name: Title:
    Home Address:  
    OwnRent    Property in name of:     Phone #:

  2. Trade References:     (Note: Include Fax Number to speed approval of your application)

    Name:
    Address:
    Contact Name:
    Phone #:        Fax #:



    Name:
    Address:
    Contact Name:
    Phone #:        Fax #:



    Name:
    Address:
    Contact Name:
    Phone #:        Fax #:



  3. Bank References:

    Name of Bank:
    Bank address:
    Contact Name:     Phone #:
    Type of account:     Account #:



    Name of Bank:
    Bank address:
    Contact Name:     Phone #:
    Type of account:     Account #:

  4. Accounts Payable Contacts:

    5. This information has been given for the purposes of obtaining credit and is certified and warranted to be true. I/We agree also that STONE & BERG may request further credit information about me/us from a credit reporting agency at any time. I/We agree that STONE & BERG may provide credit information to others without prior consent.

  1. I/We authorize the following individuals to charge goods purchased from you to my/our account:


    2.     
        

    I/We may change the authorized individuals from time to time by written notice to you at the address where payments are sent.
*Signature: *Date:     
(*)Required: Please type in necessary signature responses. Stone & Berg will mail forms back for signature of these individuals designated upon receipt by Stone & Berg of completed and signed application and terms and guarantee. Account will be opened when approved by credit department.
Upon receipt by STONE & BERG of completed and signed application, terms and conditions and Personal Guaranty of Commercial Obligations, account will be opened when approved by both controller and general manager.