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PLEASE FILL OUT THE FOLLOWING CREDIT APPLICATION, PRINT, AND FAX IT TO: Riekes Material Handling @ 515-987-7997 APPLICATION FOR CREDIT Date:_______________________ Have you ever had business relations with Riekes before? ___________ If yes, under what Business Identity? Phone Number: ( )___________________________Fax Number: ( )__________________________ Company Executive who we may contact for Financial Information:_____________________________ Accounts Payable Contact:_____________________________________________________________ We would appreciate receiving a copy of your company's latest current financial statement, which will enable your company to receive the maximum benefit of your financial position. Company Structure: If partnership, please give the names of the principals:_______________________________________ Parent or Affiliate:_____________________________________________________________________
CREDIT REFERENCES Bank Name:____________________________________Bank Officer:__________________________ Address:___________________________________________Account No:______________________ City & State:__________________________Zip:____________Phone:( )_______________________ Company Name Address City, State & Zip Phone 1._________________________________________________________________________________ 2._________________________________________________________________________________ 3._________________________________________________________________________________ 4._________________________________________________________________________________ SALES TAX EXEMPTION NUMBER _____________________________-IMPORTANT- Bank Information-Release Authorization I Hereby Authorize__________________________________Bank to Release Information on the Accounts of _______________________________to the Credit Department of Riekes Material Handling.
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