A Division of Scherba Industries Inc.
Credit Application
Please fax completed credit application back to: 330 273 3212 / Attention Accounting
Date:
Contact:
Title:
Legal Company Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Requested Credit Line: $
All of the following information is submitted in consideration of and as
a basis for an extension of credit to Scherba Industries Incorporated:
Our legal entity is:
CORPORATION
PARTNERSHIP
SOLE PROPRIETOR
If a corporation, list names of officers and titles. If other entity, list names of partners or owners.
Name:
Title:
Name:
Title:
Name:
Title:
The following represent three trade references we are currently doing business with.
Contact Name:
Title:
Acct #:
Company:
Fax:
Contact Name:
Title:
Acct #:
Company:
Fax:
Contact Name:
Title:
Acct #:
Company:
Fax:
The following represents our banking information.
Contact Name:
Title:
Bank Name:
Acct #:
Address:
Phone:
Fax:
I represent the information provided in this application to be true and authorize
(Bank:
) to release any information as required to assist in establishing a line of credit with Scherba Ind, Inc.
Name:
Title:
Signature:
Date:
The Scherba Building
2880 Interstate Parkway
Brunswick, Ohio 44212
t: 330.273.3200 f: 330.273.3212