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To establish an account, please print this form, complete,
and fax it to us at: (301) 699-3272.
If you have trouble printing out this form, please call us at (301) 459-0600
and we will be happy to fax a copy to you.
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| Name: ________________________________
D/B/A: ________________________________ Address: ______________________________ ______________________________________ Billing Address: _________________________ ______________________________________ Type of Business: ________________________ Purchase Orders Required: ________________ ______________________________________ |
Corporation: __________________________
Partnership: ___________________________ Proprietorship: _________________________ Year Started: __________________________ Year Incorporated: ______________________ Contact: _____________________________ Phone: ( )________________________ |
| Names, home addresses, telephone #'s, of Principals or Officers-Guarators | |
| 1. Name: ______________________________
Address: ______________________________ _____________________________________ SS#: _____________ D.O.B.______________ Phone: ( )_________________________ Title: _________________________________ |
2. Name: _____________________________
Address: _____________________________ ____________________________________ SS#: _______________ D.O.B.___________ Phone: ( ) ________________________ Title: ________________________________ |
| Bank References: | Trade References: |
| 1. Name: ______________________________ Address: ______________________________ Contact: ______________________________ Phone: ( ) _________________________ Acct. Number: __________________________ 2. Name: ______________________________ |
1. Company: __________________________
Address: _____________________________ _____________________________________ Contact: ______________________________ Phone: ( ) ________________________ 2. Company: __________________________
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If the customers' revenues are less than $1 million, and the application for business credit is denied, customer has the right to a written statement of the specific reason for the denial. To obtain the statement, please contact Magnolia Coach Limousine Service within 60 days from the date you are notified of our decision. We will send you a written statement of the reason for the denial within 30 days of receiving your request for the statement.
Customer affirms that the information provided above is true and correct to the best of its knowledge and agrees that Magnolia Coach Limousine Service may conduct a credit investigation containing the above references, and order a consumer credit report(s) in the case of a personal guarantee.NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating on the race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to enter into a binding contract.)
| Bank and Trade Credit Information Release Authorization |
| TO: THE BANK AND TRADE REFERENCE(S) SHOWN ABOVE: Please accept this authorization to disclose to Magnolia Coach Limousine Service or its affiliates, the customary information you would normally release to a prospective creditor including: Length of time account has been active, average monthly balances, how the account has been handled, and the details of any lending relationship. |
Signature of Customer's Officer: _________________________________ Date:________________ |
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