Integrated Case Studies

Confidential Credit Application:

The information requested below will be treated by us in strict confidence.
Contact (718) 482-1800 ext. 212 if you have any questions.

	(All fields must be filled out)
Name of Business:
Mailing Address:
City:
State:
Zip Code:
Country:
Telephone:
County & State of Incorporation:
Tax Exempt:	Yes No
	If Yes, please enter your Resale or Exempt number. A completed and signed certificate must be submitted:
Resale or Exempt #:
	Bank References
Bank 1:
Street Address:
City, State Zip:
Telephone:

Bank 2:
Street Address:
City, State Zip:
Telephone:
	Vendor References (Please do not give D&B)
Vendor 1:
Street Address:
City, State Zip:
Telephone:

Vendor 2:
Street Address:
City, State Zip:
Telephone:

Vendor 3:
Street Address:
City, State Zip:
Telephone:
	Names of Officer/Key Personnel
President/Owner:
Treasurer Partner:
Purchasing Agent:

	Please enter the letters (not case-sensitive) you see above in this field