CREDIT APPLICATION

Name

BILL TO

Company *

Last Name *

First Name *

Title *

Email for invoices *

Street *

Postal Code *

City/Province *

Phone *

Fax *

SHIP TO

Same as BILL TO Adress

Company *

Last Name *

First Name *

Title *

Email for invoices *

Street *

Postal Code *

City/Province *

Phone *

Fax *

BUSINESS INFORMATION

Federal Tax Identification No. (Please provide copy of sales text certificate)

D & B #

Type of business

Since

Annual sales

Estimated annual purchases

Trade References

Company

Address

Postal Code

City/Province

Phone

Company

Address

Postal Code

City/Province

Phone

Company

Address

Postal Code

City/Province

Phone

BANK REFERENCE

ACCOUNT #

Address

Phone

APPLICANT'S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH THE FOLLOWING TERMS: ***NET 30****

Terms and Conditions

I've acknowledged and agree to the terms and conditions of KURZ Transfer Products L.P.

All payments are to be made to KURZ Transfer Products and directed to:
P.O. BOX 63182
Charlotte, NC 28263

APPLICATION FOR CREDIT:

FINANCIAL DATA:
The following information represents the financial standing and business operation upon which KURZ TRANSFER PRODUCTS will rely for the purpose of establishing our line of credit.

Current assets

Fixed assets

Accum deprec

Total assets

Current liabilities

Long term debt

EQUITY

Paid in capitol

Stock

Retained earnings

Total liabilities

RESALE CERTIFICATE

US federal state laws require sellers to obtain a Certificate of Resale from their customers, confirming that the merchandise purchase from Kurz Transfer Products LP is to be resold in the form of tangible property. Therefore we require you to submit a Resale Certificate. Kurz Transfer Products LP is required to charge the appropriate sales tax amount for customers, who do not provide a Resale Certificate. To avoid sales tax charges, please submit a of your company's Resale Certificate.

I will send a Resale Certificate to the Kurz Finance Department shortly.

Company

Address

Postal Code

City/Province

Phone

Fax

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