About Your Business

Trade Name of Business:

Federal ID#:

Address:

City:

State/Province:

Country:

Postal/Zip:

Phone:

Fax:

Email Address:

Web Site Address:

Number of years in business:

Type of business: corporation partnership
                                      sole proprietorship

Owner:

Store manager:

Buyer:

Accounts payable:

Product Lines Sold:

Shipping Address:
(if different from above)

City:

State/Province:

Country:

Postal/Zip:

Postal/Zip:

Banking Information

Bank Name:

Bank Contact:

Phone:

Trade References

Company Name:

Address:

City:

State/Province:

Country:

Postal/Zip:

Phone:

Fax:

Company Name:

Address:

City:

State/Province:

Country:

Postal/Zip:

Phone:

Fax: