PRO GRAM ENGINEERING

475 5th ST. NE \ P.O. BOX 472  \ BARBERTON OH. 44203

Ph. (330) 745-1004 ~ Fax (330) 745-8844

 

COMPANY CHEQUE APPROVAL APPLICATION

                                                                                                                

FIRM NAME: ___________________________________________________________ DATE: ____-____-____

 

ADDRESS: _________________________________________________________________________________

 

BUS. PHONE NO. (______) ______-________  FAX NO. (______) ______-________ 

 

OWNERS NAME __________________________________   S.S.N. _____-_____-______ D.O.B. ___-___-___

 

HOME ADDRESS ___________________________________________________________________________

 

TYPE OF BUSINESS: SOLE OWNERSHIP [ ]   PARTNERSHIP [ ]   CORPORATION [ ]

 

DO YOU: OWN [ ]   RENT [ ]   LEASE [ ] YOUR BUILDING?  LENGTH OF TIME IN BUSINESS (YEARS) _______

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BANK NAME:                                                                           OFFICER'S NAME:

________________________________________________     ____________________________________________

ADDRESS:

______________________________________________________________________________________________                         

ACCOUNT NO.

________________________________________   BANK PHONE NO. (______) ______-________

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TRADE REFERENCES

 

1. NAME ________________________________________________________   PHONE NO. (____) ____-_______

   

    ADDRESS ___________________________________________________________________________________

 

    CREDIT LIMIT $________  TIME DOING BUSINESS ___________  MANNER OF PAYMENT ___________

 

2. NAME ________________________________________________________   PHONE NO. (____) ____-_______

 

    ADDRESS ___________________________________________________________________________________

 

    CREDIT LIMIT $________  TIME DOING BUSINESS ___________  MANNER OF PAYMENT ___________

 

3. NAME ________________________________________________________  PHONE NO. (____) ____-_______

 

   ADDRESS ___________________________________________________________________________________

 

   CREDIT LIMIT $________ TIME DOING BUSINESS ___________  MANNER OF PAYMENT ___________

 

                        

AUTHORIZED SIGNATURE: __________________________________________ DATE :____________________