Phoenix Credit Application

PHOENIX SPECIALTY MFG. CO.

P. O. Drawer 418, 7433 Main Highway Bamberg, South Carolina 29003

800-845-2813 TOLL FREE 803-245-5161 IN SC 803-245-4881 FAX

CREDIT APPLICATION

DATE: ______________________________

COMPANY NAME

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ADDRESS

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TELEPHONE #

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FAX#______________________________

PARENT COMPANY _______________________________________________________________________

ADDRESS

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TELEPHONE #

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FAX#______________________________

YEARS IN BUSINESS ______________________________

NO. OF EMPLOYEES _____________

NATURE OF BUSINESS

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TAX EXEMPTION OR RESALE

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ACCOUNTS PAYABLE CONTACT

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FEDERAL ID #

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BANK REFERENCE

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ADDRESS

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TELEPHONE #

_______________________________________________________________________

ACCOUNT #

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BANK REFERENCE

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ADDRESS

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TELEPHONE #

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ACCOUNT #

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