Name of Firm:
[ ] Corporation [ ] Partnership [ ] Individual [ ] Other
Date Business Started:
Has this company provided products or services to our company before?
[ ] Yes [ ] No If so, when and what type?
List current customers and their approximate purchase value.
List trade references (name, phone).
List bank references (name, branch, phone).
Completed by ____________________________ Date _____________
Approved by _____________________________ Date _____________