G B Rubber Credit Account Application

G&B Rubber Credit Application: To apply for a credit account, please complete the form below::
*Name of Company:
*Company Address:	*City:
Province/State:	Country:
*Company Phone:
Fax:
Email:
Contact Person: Position: Name of person making this application: Position: *Business Type Check one of the following: Corporation: Partnership: Proprietorship: Personal: If incorporated list names of Officers / If partnership list names of Partners Bank: Branch: * Phone: Bank: Branch: Phone: Business Reference 1: Address: * Phone: Business Reference 2: Address: Phone: Business Reference 3: Address: Phone: I/We make application for a charge account and certify that the information given above for the purpose of opening this account are true. I/We authorize verification of the above given information.