Credit Reference Form

OUR CLIENT IS APPLYING FOR A CREDIT LINE WITH US, AND HAS GIVEN US YOUR COMPANY AS A CREDIT REFERENCE. KINDLY PROVIDE US WITH THE FOLLOWING INFORMATION AND SUBMIT THIS FORM BACK TO US. THIS WILL ONLY BE RECIEVED BY OUR ACCOUNTING DEPARTMENT. WE ASSURE YOU THAT THIS INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL. Your immediate reply will be much appreciated.
Date Account Opened:(Required)
Date of Last Sale:(Required)
Name(Required)
Today's Date(Required)