Massasoit Tool Company

  


Massasoit Tool Company
110 Minnesota Avenue · Warwick, RI 02888-6026
Tel. (800) 648-6050 · Fax (800) 274-8424
 

APPLICATION FOR CREDIT


PLEASE PRINT ALL PAGES, COMPLETE, AND FAX TO 1-800-274-8424 OR
MAIL TO MASSASOIT TOOL COMPANY AT THE ADDRESS SHOWN ABOVE.





NAME OF FIRM OR INDIVIDUAL AS IT APPEARS ON YOUR CHARTER



BILLING ADDRESS



CITY

  



STATE

  



ZIP CODE



YEARS AT THIS ADDRESS

  



PHONE NUMBER

  



FAX NUMBER

PURCHASER CERTIFIES THESE PURCHASES TO BE (CHECK ONE)
[   ] TAXABLE     [   ] NON-TAXABLE
(IF NON-TAXABLE, PLEASE SUPPLY US WITH YOUR USER-EXEMPT OR RESALE CERTIFICATE)

[   ] CORPORATION     [   ] PARTNERSHIP     [   ] INDIVIDUAL
[    ] CHECK HERE IF INCORPORATED WITHIN THE PAST 12 MONTHS

NAMES OF PRINCIPLES   (PLEASE INCLUDE COMPLETE ADDRESS AND PHONE NUMBER OF ALL PRINCIPLES)



1.  

     


2.  

     


3.  

     


4.  

     




BANK REFERENCE
 
BANK NAME  
     
FULL ADDRESS  




OFFICER OR DEP'T     PHONE NUMBER  

ACCOUNT REFERENCES

1. BUSINESS NAME     YOUR ACCOUNT #  
     
FULL ADDRESS  




PHONE NUMBER     FAX NUMBER  

CONTACT PERSON  

2. BUSINESS NAME     YOUR ACCOUNT #  
     
FULL ADDRESS  




PHONE NUMBER     FAX NUMBER  

CONTACT PERSON  

3. BUSINESS NAME     YOUR ACCOUNT #  
     
FULL ADDRESS  




PHONE NUMBER     FAX NUMBER  

CONTACT PERSON  



[   ] CHECK HERE IF CASH SALES ARE ACCEPTABLE UNTIL CREDIT IS APPROVED

HOW DID YOU HEAR ABOUT US?


WE CERTIFY THAT ALL INFORMATION ON THIS FORM IS CORRECT




AUTHORIZED SIGNATURE

  



TITLE

 



DATE SIGNED