CREDIT APPLICATION Fax or Mail Credit Application to: Universal Companies Inc. | 18260 Oak Park Drive | Abingdon, VA 24210 1.800.558.5571 | Fax: 1.800.237.7199 Completed application must contain all information requested to be processed. UNIVERSAL CUSTOMER NUMBER: _________________ CREDIT FOR: CREDIT LIMIT REQUESTED: _______________________ BUSINESS INFORMATION Telephone, e-mail, fax, and online orders. Telephone, e-mail, and fax orders only. Legal Name of Business: Federal ID#: Doing Business As: E-mail Address: Street Address: City: State: Zip: Billing Address: City: State: Zip: Phone #: Fax #: Website Address: Accounts Payable Contact: Phone #: Email Address: Business Start Date: Date of Incorporation: Description of Business: Check One: Proprietorship Corporation LLC Non-Profit Other Number of Employees: D & B Number: OWNERS/PRINCIPLES/PARTNERS (Required) (Required for online account terms) Name & Title: Social Security #: Home Phone #: E-mail: Percent of Ownership: Home Address: City: State: Zip: Name & Title: Social Security #: Home Phone #: E-mail: Percent of Ownership: Home Address: City: State: Zip: BANK REFERENCES Bank Name: Account # – Checking: Address: City: State: Zip: Phone: Fax #: Contact/Title: E-mail: TRADE REFERENCES Name: Phone #: Fax #: Account #: Contact: E-mail: Name: Phone #: Fax #: Account #: Contact: E-mail: Name: Phone #: Fax #: Account #: Contact: E-mail: The undersigned represents that all information provided with this application is true and correct and hereby authorizes Universal Companies, its designees, assigns or potential assigns, to obtain from third parties, information it deems necessary to arrive at a decision regarding this application. To help fight terrorism and money laundering, the information you provide will be verified. The undersigned, as designated signer for all deposit, borrowing, financial, and trade information, authorizes all deposit, borrowing, financial, and trade information to be released to Universal Companies, its designees, assigns or potential assigns, by mail, telephone or fax. A photocopy or facsimile of this authorization shall be valid as the original. Your valid email address will allow Universal Companies to contact you by email, should it be necessary. Authorized Signature: Title of Signatory (must be owner or officer): Printed name of Signatory: Date: ® ® 6= Earth Friendly Products YOUR ONE SOURCE SPA SOLUTION® | 1.800.558.5571 UNIVERSALCOMPANIES.COM 479
2016_Spa_Resource&Equip_Book
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