Credit Application

Bubrick's Complete Office
PO Box 640
N115 W18500 Edison Drive
Germantown, WI  53022
262-255-5500
Fax: 262-255-4695
 
APPLICATION FOR CREDIT
 
Date:
Name of Applicant:
 
BILLING ADDRESS:
Address 1:
Address 2:
City:
County:
State:  Zip: 
 
DELIVERY ADDRESS:
Address 1:
Address 2:
City:
State:  Zip: 
 
IF NOT SUBJECT TO STATE AND CITY SALES TAX,
PLEASE SUPPLY US WITH A COPY OF YOUR TAX EXEMPTION CERTIFICATE
Bank:
Address 1:
Address 2:
Phone:  
Fax:  
 
PLEASE LIST THREE TRADE REFERENCES WHERE YOU NOW HAVE ACCOUNTS
PLEASE SUPPLY FAX NUMBER WHERE POSSIBLE AS MOST COMPANIES
WILL NOT RELEASE CREDIT INFORMATION OVER THE PHONE.
 
FIRST
Name:
Address 1:
Address 2:
City:
State:  Zip: 
Phone:  
Fax:  
 
SECOND
Name:
Address 1:
Address 2:
City:
State:  Zip: 
Phone:  
Fax:  
 
THIRD
Name:
Address 1:
Address 2:
City:
State:  Zip: 
Phone:  
Fax:  
 
THE ABOVE INFORMATION IS FOR THE PURPOSE OF OBTAINING CREDIT AND IS WARRANTED TO BE TRUE. OUR TERMS ARE NET 30. IF ANY ACCOUNT IS DEEMED DELINQUENT, WE RESERVE THE RIGHT TO DELIVER ON C. O. D. BASIS ONLY. FURTHER CREDIT WOULD HAVE TO BE ESTABLISED WITH OUR BUSINESS OFFICE.