Laserfiche WebLink
wwra. <br /> WASTE MANAGEMENT <br /> Credit Application <br /> SECTION 1: Customer Profile <br /> rrofil ! <br /> Company Name: S I li �' Phone: ( q1��q) <br /> � -, �/'✓ <br /> Street dress: EJ S Fax:('/ ,_ <br /> City: � � State: ' <br /> Type of Business: Year Established: <br /> Officer or Proprietor: 1 ! Taxpayer ID#: Z)_Z;�4, <br /> If a proprietorship/individual—Soc al Security#: Driver's License#: 1(41-4 <br /> Home Address: Home Phone#( )4 L4 <br /> SECTION 2: Credit Request <br /> Estimated Billing for Current Service Request: Average Billing for Existing Services: <br /> Aggregate Monthly Billing: <br /> SECTION 3: Billing Information <br /> Preferred Payment Method: O Check 13 EFT/ACH Draft <br /> El Credit Card: 0 MasterCard 0 Visa (Acct. 9 Exp. Date_) <br /> Payment Contact Name: Payment Contact Phone#: <br /> Pr-CTION 4: Trade/Business References <br /> (Affiliated companies cannot be onsidered as trade references. If used,this may result in cancellation of credit privileges) <br /> 1 2 3 <br /> Company Name <br /> Address <br /> Phone Number <br /> Fax Number <br /> SECTION 5: Bank Referenc s, <br /> Bank Name: L <br /> Address: <br /> l <br /> Account#: <br /> Phone:( ) Fax:( ) <br /> THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. I AM AWARE THAT ANY AND ALL INVOICES <br /> RENDERED ARE EXPECTED TO BE 3AID WITHIN STATED TERMS AND THAT FAILURE TO COMPLY COULD RESULT IN THE <br /> CANCELLATION OF EXTENDED CREDIT PRIVILEGES. <br /> THE UNDERSIGNED AUTHORIZESP LL PARTIES CONTACTED TO RELEASE CREDIT AND FINANCIAL INFORMATION <br /> REQUESTED AS PART OF CREDIT INVESTIGATION. <br /> orized Signature/Title: Date: <br /> Sales Representative Signature: Date: <br /> Sales Manager Signature: Date: <br />