Credit Application Form for Atlas Case

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Credit Application Form
Fill out and FAX or Mail back to Atlas

For the purpose of obtaining merchandise on credit, the undersigned certifies the following statement to be true and correct. We, hereby, authorize Atlas Case, Inc. to contact these references to obtain our credit history.
Company Name:_______________________________________________________________
Street Address:_________________________________________________________________
City:________________________________State:_______ Zip:___________
Telephone:(_____)______________FAX:(_____)___________
How long in Present Business:_______________________
Type of Business: (check one) Proprietorship[_]Partnership[_]Corporation[_]
Purchases are: Taxable[_]Resale[_] (Please provide a resale certificate for City and State)
Please list at least four firms with whom you have open credit:
Company Name	Telephone	Fax	Contact	Account #
1._________________ __________________	(____)________	(____)________	______________	________________
2._________________ __________________	(____)________	(____)________	______________	________________
3._________________ __________________	(____)________	(____)________	______________	________________
4._________________ __________________	(____)________	(____)________	______________	________________
Bank:________________________________________________			Branch:_________________________________
Address:________________________________________________________________________________________
Phone: (____)_______________
Account Number(s):_________________________________________________________________
Bank Contact:___________________________________________________________

Atlas Case, Inc. may contact the above firms to verify the status of our (my) accounts. If not paid when due, this account shall bear interest at the maximum rate allowed by law. Should litigation arise with regard to the status of our (my) account, we (I) will be responsible for all collection costs, reasonable attorney's fees and related costs. Signature of Corporate Officer:________________________________ Title:____________________ Date:____________ Signer's Printed Name:_______________________________