Sales
Rental
Repair
747
Boise, ID 208-377-0158
Eugene, OR 541-342-3641
Idaho Falls, ID 208-522-7082
Medford, OR 541-779-0187
Acct#
APPLICATION FOR CREDIT
Credit Limit
Class
Branch #
Sales Rep #
ER
Company Name
Credit Limit Requested
Mailing Address
Phone
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Street
City
State
Zip
Business Address
Phone
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)
Street
City
State
Zip
Business License #
Federal ID #
Fax phone (
)
Contractors Bond #
Type of Business
Bond Company
If in Oregon CBC #
Type of Business Corporation
Partnership
Individual
Government
As Applicable, List name(s) and address(es) or Corporate Officers, Parnters, or Owners:
Name
Social Security #
Please print
Home Address
Phone
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)
Street
City
State
Zip
Name
Social Security #
Please print
Home Address
Phone
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)
Street
City
State
Zip
Name of Person Responsible for Accounts Payable
Date Business Established
# of Employees
# of Years at Present Location
Name of Bank
Branch
Checking Acct #
Have You Ever Filed Bankruptcy? NO_____ Yes ______ Under What Name_____________________ Date
Which Edge Construction Supply branch do you most often do business with?
___Spokane ___ Billings ___Yakima ___Boise ___Eugene ___ Gillette ___Medford ___Idaho Falls
* If out of town Contractor - what local job
Local Job Address
Phone
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Street
City
Local Job Contact
Phone
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)
Trade References
: (Must include complete address and phone number)
Company
Phone
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Address
Fax
(
)
Street
City
Company
Phone
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)
Address
Fax
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)
Street
City
