APPLICATION FOR CREDIT
Required Entry Required Entry
 

Required Entry NAME OF FIRM OR INDIVIDUAL

Required Entry ADDRESS

Required Entry CITY/ST/ZIP
OSCEOLA SUPPLY, INC. REMIT TO: OSCEOLA SUPPLY, INC.
915 COMMERCE BLVD P.O. BOX 13503
MIDWAY, FL 32343 TALLAHASSEE, FL 32317
   
PHONE: 850-580-9800 FEID: 59-3181370
FAX: 850-580-8001  
OWNERSHIP INFORMATION
 
Required Entry
CORPORATION
PARTNERSHIP
INDIVIDUAL
YEAR INCORPORATED
 
NAME(S) OR PRINCIPALS(S) ADDRESS PHONE

FINANCE & REFERENCES


BANK


ACCT#

CONTACT
PHONE#
 
TRADE REFERENCES ADDRESS PHONE

Required Entry WE CERTIFY ALL INFORMATION IS CORRECT AND AGREE TO PROPER PAYMENT IN CONSIDERATION OF EXTENDED CREDIT

PLEASE TYPE FULL NAME
TITLE
   
INTERNAL USE

REFERENCES CHECKED BY
CREDIT APPROVED BY

REFERENCE RESULTS
CREDIT DENIED BY
 
DATE