General Information *Credit Limit Requested $      *AmesburyTruth or Bilco BilcoAmesburyTruth      Company Information *Business Name       Doing Business As (DBA Name)      *Tax ID        *Billing Address      *City      *State/ Province AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWYABBCMBNBNLNSNTNUONPEQCSKYT      *Zip/Postal       Country United States Of AmericaCanada      *Billing Address      *City      *State/ Province AKALARASAZCACOCTDCDEFLFMGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRPWRISCSDTNTXUTVAVIVTWAWIWVWYABBCMBNBNLNSNTNUONPEQCSKYT      *Zip/Postal       Country United States Of AmericaCanada      *Accounts Payable Contact Name      *Telephone      *Email Address       Fax Number      *Legal Structure Not AvailableSole ProprietorshipLimited Liability CompanyCooperativeCorporationNonprofit CorporationS CorporationPartnershipLimited Partnership      *Type of Business      *Are you Tax Exempt?  Yes    No       Number of Employees       Year Business Established       Business Website      Trade References - complete here or attach down below  Reference Name       Contact Name       Phone Number       Contact Email       Reference Name       Contact Name       Phone Number       Contact Email       Reference Name       Contact Name       Phone Number       Contact Email      Bank Reference Information *Bank Name       Bank Account Number       Bank Account Type CheckingSavingsBrokerageCredit CardLine of CreditLoanLeaseOther      *Bank Phone Number       Bank Fax Number      *Bank Contact Name      Attachments ATTACHMENT INSTRUCTIONS - In order to comply with state sales tax law requirements, it is necessary that we have on file a current blanket resale or tax exemption certificate for all customers who claim a sales tax exemption. If you prefer to attach a credit reference document, please do so here. Attachment Description Attachment Location * Upload Upload Upload Note: Accepted file formats include PDF, CSV, TXT and various image files (JPEG, JPG, GIF, BMP, TIFF, TIF, PNG, ICO). File attachments must not exceed 10 MB in combined size.

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