Text Box: Type Of Business: _______________________ Business Start Date: _____/_____/_____ Owner: _________________________ Contact: _________________________ Resale #: ________________ DNB# ________________ Fed. ID#: ________________ SSN: ________________

Text Box: CREDIT APPLICATION Shield Products, Inc. 5205 Bischoff Avenue, Saint Louis, MO 63110 Office: 314-865-5550 Fax: 314-865-5556 Email: shieldproducts@sbcglobal.net

 

 

 

 

Legal Business Name: ____________________________________________________________

Text Box: TRADE REFERENCES: Name: _______________________________ Name: _________________________________ Name: ___________________________ Address: ______________________________ Address: _______________________________ Address: _________________________ City: ________ St.: _____ Zip: _____________ City: ________ St.: _____ Zip: _____________ City: ________ St.: _____ Zip: ________ Phone: ______________ Fax: _____________ Phone: ______________ Fax: _____________ Phone: ______________ Fax: _________ Account#: _____________________________ Account#: _____________________________ Account#: _________________________ Doing Business As:      ____________________________________________________________

 

Text Box: Ship To Address: Address: _________________________________ City: ________________ ST.:_____ Zip: _______ Phone: _______________ Fax: _______________ Text Box: Bill To Address: Address: _________________________________ City: ________________ ST.:_____ Zip: _______ Phone: _______________ Fax: _______________

 

 

 

 

 

Text Box: Bank Reference Name & Address: ____________________________________________________________________________________________ Contact: ______________________ Phone: _________________ Fax: __________________ Acct.# __________________________

 

 

 

 

 

 

The undersigned hereby notifies that the information contained in the application is true and correct.  In addition to the foregoing, the undersigned expressly agrees that in the event of any action or proceedings shall be brought for the recovery of amounts due for products or merchandise obtained from Shield Products, Inc., or its assigns, to pay all costs for collection including but not limited to attorney’s or collection agent’s fees.  The undersigned further agrees to pay a $25.00 charge for each returned check.  The undersigned gives this information for the purpose of obtaining credit and authorizes Shield Products, Inc. to obtain additional information concerning this credit standing and to furnish the same to others. 

 

Date: ___/___/___   Signature of Owner or Officer: ________________________________ Title: ____________________________