American Conveyor Group, Inc. - Credit Application

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	American Conveyor Group 136 Tennsco Drive - Dickson, TN 37055 Ph: 866-403-5232 - Fax: 615-560-4027
	*DESIGN - ENGINEERING - SALES - INSTALLATION - MAINTENANCE - SERVICE*

American Conveyor Group, Inc.
136 Tennsco Drive
Dickson, TN 37055
PHONE 866-403-5232 FAX 615-560-4027
Email:
http://www.acgconveyors.com

PLEASE FILL OUT THE FOLLOWING CREDIT APPLICATION, PRINT, AND FAX IT TO:

American Conveyor Group, Inc. @ 615-560-4027

APPLICATION FOR CREDIT

DATE:_______________________

ISSUED TO: American Conveyor Group, Inc.

FIRM NAME: (NAME OF FIRM REQUESTING STATEMENT)
___________________________________________________________________________________

MAILING ADDRESS: _____________________________________ PHONE:_____________________

CITY: __________________ STATE: ______________ ZIP CODE: _____________________________

FULL NAME OF OWNER OR OWNERS (OR AN AUTHORIZED OFFICER OF CORPORATION)
LIST HOME ADDRESS & ZIP CODE FOR PARTNERSHIP OR INDIVIDUAL.
1._________________________________________________________________________________

2._________________________________________________________________________________

PLEASE CHECK ONE:	INDIVIDUAL	PARTNERSHIP	CORPORATION	FED. TAX NO.

ADDITIONAL INFORMATION REQUIRED FOR CONDITIONAL SALES CONTRACTS UNDER THE UNIFORM COMMERCIAL CODE.

DEBTOR INDIVIDUAL SIGNING CONTRACT: ______________________________________________

TITLE:___________________________________

DEBTORS SOCIAL SECURITY NO: (FOR PARTNERSHIP OR INDIVIDUAL)_____________________

TYPE OF BUSINESS __________________________________

DATE STARTED_______________________

WE EXPECT OUR MONTHLY CREDIT REQUIREMENTS FROM YOU TO BE ABOUT $______________________

FORMER BUSINESS ________________________________ LOCATION ______________________

OWN OR RENT BUILDING - IF RENT, FROM WHOM?_______________________________________

REAL ESTATE MORTGAGE:____________________________________________________________

TRADE REFERENCES

NAME MAILING ADDRESS CITY STATE ZIP

1)___________________________________________________________________________________

2)___________________________________________________________________________________

3)___________________________________________________________________________________

NAME OF BANK:
CONTACT:
ACCOUNT NO:
MAILING ADDRESS:
CITY / STATE / ZIP

APPLICANTS SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH FOLLOWING TERMS: NET 10

FIRM NAME:

BY:		TITLE: