ATLANTIC STAINLESS CO., INC.
140 John Dietsch Sq., N. Attleboro, MA 02763 • (800) 458-6595 • Fax (508) 699-8311

BILL TO:  
SHIP TO:
EXACT NAME _____________________________
 
ADDRESS ________________________________

CITY _____________ STATE _____ ZIP ________

PHONE # _____________ FAX # _____________
NAME ____________________________________
 
ADDRESS ________________________________

CITY _____________ STATE _____ ZIP ________

PHONE # _____________ FAX # _____________

GENERAL BUSINESS INFORMATION
TYPE OF BUSINESS ______________________________________ YEARS IN BUSINESS __________

ACCOUNTS PAYABLE CONTACT _________________________________________________________

D.B.A. ________  INDIVIDUAL ________  PARTNERSHIP _________  CORPORATION ________
 
TITLE ________________________  RES. ADDRESS ________________________________________
 
CHECK ONE: ______ OWNER  ______ PARTNER  ______ PRINCIPAL  ______ STOCK HOLDER
 
Are you Sales and/or Use Tax Exempt?  YES ______  NO ______

If yes, please insert your certificate number below, and send a copy of certificate with credit application.
 
CERTIFICATE # ______________________________________________________________________

BANK REFERENCE
BANK NAME _________________________________ OFFICER HANDLING ______________________
 
ADDRESS ___________________________________________ PHONE # _______________________
 
CHECKING ACCOUNT # _____________________ SAVINGS ACCOUNT # _______________________

BUSINESS REFERENCES (Material Suppliers)
           NAME                            ADDRESS                           PHONE/FAX #                 ACCT #
 
1. ________________________________________________________________________________
 
2. ________________________________________________________________________________
 
3. ________________________________________________________________________________
CONTINUING WARRANTY:  In consideration of the extension of credit by the Seller, herein to Buyer herein, the undersigned does jointly and severally personally guaranty to pay and be responsible for payment of all sums, balances and accounts due Seller by Buyer, including collection charges and/or attorney's fees.
 
Date ______________  Signature _______________________________________________________
 
We certify that all the information on this form is correct: and that we fully understand your credit terms, including the service charge on overdue invoices, and agree to the proper payment in consideration of extended credit, including the charges made by a collection agent up to 40% of the balance due, and in the event of suit, reasonable attorney's fees and court costs.
 
Date ______________  Signature _______________________________ Title ___________________