KMR Credit Application

Delivery Date

Company Name

Bill to Address

Bill Tel. No

Bill Fax No

Ship to Address

Ship Tel. No

Ship Fax No

Accounts Payable Contact

Accounts Fax No

Accounts E-mail

G.S.T./ H.S.T No

Length of Time in Business

Months

Years

Bank

Bank Contact

Bank Tel. No

Bank Fax No

Bank Email

References1 Company Name

References1 Contact

References1 Tel. No

References1 Fax No

References1 E-mail

References2 Company Name

References2 Contact

References2 Tel. No

References2 Fax No

References2 E-mail

References3 Company Name

References3 Contact

References3 E-mail

References3 Tel. No

References3 Fax No