Business Credit Application for Lamers

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Lamers Enterpris, Inc
251 Puuhale, Road,						For fast credit Approval
Honolulu, Hi 96819						Please fax to:
PH: 808-845-9365						8080545-5592
Attn: Credit Division				Sales Rep	_____________
Type of Business		_____________________________________________
Phone number		_____________________________________________
Fax number		_____________________________________________
					City	State
Billing address		_________________________________________
Shipping address		_________________________________________
Type of ownership		__ Corporation		__ Partnership		__ Sole Proprietor
		__ Government		__ Non- Profit		__ Others_________________
Years in business		________	Years	Tax Examption? ____ yes, ____ No,
Parent company's name (If different than above):
Address		________________________________________________________________
					City
				BANK REFERENCE
Bank name		_________________________	________________		________________
Account #		_________________________			Phone number
Contact at bank		_________________________
Bank name		_________________________			________________
Account #		_________________________			Phone number
Contact at bank		_________________________
			OPEN ACCOUNT REFERENCE- Locals only
Name of business					________________
					Phone number
Address		________________________________________________________________
					City
Name of business					________________
					Phone number
Address		________________________________________________________________
					City
Name of business					________________
					Phone number
Address		________________________________________________________________
					City
Authrized Signature		_________________________			Date	_________________________
Print name		_________________________			Title	_________________________
Inter Office use only			Date approved		Date	_________________________
Credit limit $		_________________________			Note	_________________________