Please type in or fill out with heavy dark ink.	Return all application forms to Fax No: (818) 782-0799
Matfer Bourgeat Commercial Credit Application - Year 2006

 

Corporation:  Yes  No	Proprietorship:  Yes  No
Limited Liability Company:  Yes  No	Sole Proprietorship:  Yes  No
Other:  Yes  No	If Yes, Business Type:
State Resellers License #:	(Please attach a copy of your Tax Exemption Certificate):
Federal ID:	Social Security ID:
No State Sales Tax in:

Date Business Began:	Date of Incorporation or Association:
Retailer:  Yes  No	Wholesaler:  Yes  No
Dealer:  Yes  No

Legal Name of Business:	DBA and/or AKA(s):

BILLING ADDRESS Company Name:  First Name:  Last Name:  Address 1:  Address 2:  City:  State:  Zip Code:  Tel:  Fax:  E-mail:  SHIPPING ADDRESS (if different than "Billing Address") Company Name:  First Name:  Last Name:  Address 1:  Address 2:  City:  State:  Zip Code:  ACCOUNTS PAYABLE Contact Name:  Tel:  Fax:  E-mail:  BUYER   Contact Name:  Tel:  Fax:  E-mail:  This screen form will NOT be sent to us electronically. Your choice of the browser PRINT icon will cause this screen form to be printed out with all your input variable data and ready for fax or post office mail. Please sign the signature block after the form is printed or before faxing or mailing.