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wwr��- <br /> WASTE MANAGEMENT <br /> CREDIT APPLICATION <br /> SECTION 1: Customer Pr file <br /> Company Name: / �� �/` l P_ I �/� '_'�� �/t�) r r l� W Lill Phone: ( q( ) G%�� 1 1-4 <br /> Street Address: )0 /- J Fax: <br /> City: ill , n CA State: i- <br /> Type of Business: " f Of/(?_1 ik b. Year Established: <br /> Officer or Proprietor: Taxpayer ID#: 7 <br /> If a proprietorship/ individual—So ial Security Driver's License#- <br /> Home Address: � Home Phone# ( ) <br /> SECTION 2: Credit Reques <br /> Estimated Billing for Current Servi a Request: Average Billing for Existing Services: <br /> Aggregate Monthly Billing: <br /> SECTION 3: Billing Inform tion <br /> Preferred Payment Method: 13 Check 13 EFT/ACH Draft <br /> 03 Credit Card: 0 MasterCard 0 Visa (Acct.# Exp. Date <br /> Payment Contact Name: Payment Contact Phone#: <br /> CTION 4: Trade/Busines 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 %7 <br /> Address <br /> Phone Number <br /> Fax Number <br /> SECTION 5: Ban References / <br /> Bank Name: _ C, . z, l h' <br /> Address: <br /> Account#: <br /> Phone:( ) Fax:( ) <br /> THE ABOVE INFORMATION IS CORR CT TO THE BEST OF MY KNOWLEDGE. I AM AWARE THAT ANY AND ALL INVOICES <br /> RENDERED ARE EXPECTED TO BE AID WITHIN STATED TERMS AND THAT FAILURE TO COMPLY COULD RESULT IN THE <br /> CANCELLATION OF EXTENDED CRE IT PRIVILIGES. <br /> UNDERSIGNED AUTHORIZES AL PARTIES CONTACTED TO RELEASE CREDIT AND FINANCIAL INFORMATION <br /> .)ESTED AS PART OF CREDIT INV STIGATION. <br /> 1/ Authorized Signature/Title: TC42aDate: <br /> Sales Representative Signature: Date: <br /> I <br />