Marmon/Keystone LLC
APPLICATION FOR CREDIT
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Location nearest you
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Atlanta, GA
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Location Contacts:
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Applicant's Legal Name:
Billing Address
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Street/P.O. Box
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City
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State
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Zip
Shipping Address
Street/P.O. Box
City
State
Zip
Accounts Payable contact:
Email:
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Phone Number:
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Fax Number:
DUNS#:
S I C Code:
Firm Opened Business (year):
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Legal Status
Corporation
LLC
Partnership
Sole Proprietor
Monthly Credit Line Required:
Division/Subsidiary of:
Credit References
(granting highest credit, include tubing suppliers - same industry)
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Name:
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Address: (City, State)
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Phone:
Fax:
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Name:
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Address: (City, State)
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Phone:
Fax:
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Name:
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Address: (City, State)
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Phone:
Fax:
Name:
Address: (City, State)
Phone:
Fax:
Bank Reference
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Name:
Checking Account#:
Address: (City, State)
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Phone:
Fax:
Bank (Officer) Contact:
Comments:
Please click the browse button to attach a copy of your Tax Exempt Certificate or tax will be charged.
I hereby authorize a confidential bank credit rating be given to Marmon/Keystone LLC on the above account.
I agree
I DO NOT agree
I/We warrant that the firm is not presently in bankruptcy unless noted. It is agreed that payments will be made within terms of 1/2% 10 net 30, and further agreed that if our account becomes delinquent, to pay all costs and expenses of collection, including reasonable collection fees and suit costs.
I agree
I DO NOT agree