Name of Bank Contact by 67TJqg

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									                                                             CREDIT APPLICATION Fax 814-899-9862
Company Name: ___________________________________       Purchasing Contact: ________________________
Address: ______________________________________________________________________________________
City: _________________________________________ State: ________________       Zip: ___________________
A/P Contact: __________________________________ Phone: __________________Fax: __________________
Shipping Address: ___________________________________________________________________________
City: ________________________________________              State: ________________  Zip:___________________
Shipping Contact: ______________________________            Phone: __________________Fax: __________________

BANK REFERENCES
Name of Bank: _____________________________________     Contact: _________________________________
Address: ______________________________________________________________________________________
City: _________________________________________ State: ________________ Zip: ____________________
Phone: _______________________________________ Fax: ___________________________________________
Account Number: ________________________   Checking: ____________________ Savings: ________________

TRADE REFERENCES
Company Name: ____________________________________ Contact: _________________________________
Address: ______________________________________________________________________________________
City: ________________________________________  State: _________________ Zip: ____________________
Phone: ______________________________________   Fax: ___________________________________________

Company Name: ____________________________________ Contact: _________________________________
Address: ______________________________________________________________________________________
City: ________________________________________  State: _________________ Zip: ____________________
Phone: ______________________________________               Fax: ___________________________________________

Company Name: ____________________________________ Contact: _________________________________
Address: ______________________________________________________________________________________
City: ________________________________________  State: _________________ Zip: ____________________
Phone: ______________________________________   Fax: ___________________________________________

Company Name: ______________________________________ Contact: _________________________________
Address: ______________________________________________________________________________________
City: ________________________________________  State: _________________ Zip: ____________________
Phone: ______________________________________   Fax: ___________________________________________

I (We) certify the above information is true and correct. I (We) authorize the release of information needed for
processing this application to JTM Foods, Inc.

Name: _______________________________                Title: ___________________________            Date: ____________

								
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