Dot Gibson Credit Application (Print, Fill Out and Fax)

Company Name:______________________________________________________________

Sole Prop., Partnership or Corp:___________________________________________________

Bill To:______________________________________________________________________

Ship To:_____________________________________________________________________

City:__________________________________State:_________________Zip:_____________

Phone #:(____)________________________Fax:(____)_______________________

Years in Business _________________________Tax #:_______________________________

Bank (Include Address, Phone Number)

____________________________________________________________________________

____________________________________________________________________________

Trade References (Include Address, Phone # and Account #)

1.___________________________________________________________________________

____________________________________________________________________________

2.___________________________________________________________________________

_____________________________________________________________________________

3.___________________________________________________________________________

_____________________________________________________________________________

4.___________________________________________________________________________

_____________________________________________________________________________