Jelinek Cork Credit Application — Jelinek Cork Group®

Credit Application

Legal Business Name

Years in Business

Business Identification Type

Business Identification Number

Officers of Company

Account Payable Contact

First Name

Last Name

Phone

(###)

###

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Email

Bank Name

Bank Manager

First Name

Last Name

Bank Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Desired Payment Method

If Net30 Amount of Credit Desired

Major Supplier Information

Supplier 1

Supplier 1 Business Name

Supplier 1 Email

Supplier 1 Phone

(###)

###

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Supplier 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supplier 2

Supplier 2 Business Name

Supplier 2 Email

Supplier 2 Phone

(###)

###

####

Supplier 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supplier 3

Supplier 3 Business Name

Supplier 3 Email

Supplier 3 Phone

(###)

###

####

Supplier 3 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Supplier 4

Supplier 4 Business Name

Supplier 4 Email

Supplier 4 Phone

(###)

###

####

Supplier 4 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country