MARYLAND CHEMICAL CUSTOMER CREDIT APPLICATION
NAME
 _____________________________________________________
ADDRESS
 _____________________________________________________
  _____________________________________________________
  _____________________________________________________
TELEPHONE NUMBER
 _____________________________________________________
FAX
 _____________________________________________________
CONTACTS
PURCHASING
_____________________________________________________
ACCOUNTS PAYABLE
_____________________________________________________
OFFICERS
 _____________________________________________________
FORM OF BUSINESS
INDIVIDUAL
 _____________________________________________________
PARTNERSHIP
 _____________________________________________________
CORPORATION
 _____________________________________________________
FEDERAL TAX ID#
 _____________________________________________________
TYPE OF BUSINESS
 _____________________________________________________
DATE STARTED
 _____________________________________________________
ANNUAL SALES
 _____________________________________________________
D & B #
 _____________________________________________________
AMOUNT OF CREDIT REQUESTED
 _____________________________________________________
BANK REFERENCE
NAME OF BANK
 _____________________________________________________
ADDRESS
 _____________________________________________________
  _____________________________________________________
TELEPHONE
 _____________________________________________________
CONTACT
 _____________________________________________________
YOUR ACCOUNT NUMBER AT BANK
 _____________________________________________________
TRADE REFERENCES
NAME
 _____________________________________________________
ADDRESS
 _____________________________________________________
_____________________________________________________
TELEPHONE
 _____________________________________________________
FAX
_____________________________________________________
CONTACT
 _____________________________________________________
NAME
 _____________________________________________________
ADDRESS
 _____________________________________________________
_____________________________________________________
TELEPHONE
 _____________________________________________________
FAX
_____________________________________________________
CONTACT
 _____________________________________________________
NAME
 _____________________________________________________
ADDRESS
 _____________________________________________________
_____________________________________________________
TELEPHONE
 _____________________________________________________
FAX
_____________________________________________________
CONTACT
 _____________________________________________________

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