Credit Application

COMPANY
CONTACT
BILLING ADDRESS
SHIPPING ADDRESS
PHONE #	E-mail:
FAX#	YEARS IN BUSINESS
ACCOUNTING #	ARE PURCHASE ORDERS REQUIRED?? YES NO
	HARD COPY OR VERBAL
AUTHORIZED PURCHASERS:
ARE YOU TAXABLE?	YESNOTAX ID #
SPECIAL REQUIREMENTS
BANKING REFERENCE: PHONE # FAX #	BANK OFFICER ADDRESS
Please- We Require 3 References BUSINESS REFERENCE # 1 PHONE # FAX # EMAIL	NAME CONTACT ADDRESS
BUSINESS REFERENCE # 2 PHONE # FAX # EMAIL	NAME CONTACT ADDRESS
BUSINESS REFERENCE # 3 PHONE # FAX # EMAIL	NAME CONTACT ADDRESS

If you prefer: Feel free to print this form and fax to 713-652-1919
or email to info@brownbookshop.com

It is not necessary to do this, the information will be transmitted when you "submit".