CREDIT APP

Name

Address

City

State

Zip

Phone

Fax

Years in Business

Email

Person Making Application (if entity)

Title

Type of Account


Federal FEIN

(or)

Social Security

Tax Exempt

Resale

Name(s) of Officer(s) and Title

Complete Address, City, State, Zip

Phone

Name(s) of Officer(s) and Title

Complete Address, City, State, Zip

Phone

Name(s) of Officer(s) and Title

Complete Address, City, State, Zip

Phone

Name(s) of Officer(s) and Title

Complete Address, City, State, Zip

Phone

Do you require a purchase order?

No restrictions charge will be placed on this account unless a specific list of authorized users is provided. Any changes to the list must be submitted in writing.

Proposed Initial Authorized Signers:

I/We certify that all the information provided in this form is correct. I/We understand that this application does not guarantee credit approval and approval of credit and the amount of credit granted is in the sole discretion of West Side Lumber. Furthermore, I/We understand that approval of credit by West Side Lumber shall require entering into a contract. I/We approve and authorize West Side Lumber obtaining information from the above references and a credit report on my company or if not an entity, a report on myself/us individually. If approved for credit and I/we subsequently request a renewal, update, or extension of the line of credit, West Side Lumber may request a new Charge Application or may request a new credit report without notice.

Name

Title (if Applicable)