Sample Buyer Application

Buyer's Name ______________________________________________________

Business Name _____________________________________________________

Mailing Address ____________________________________________________

City _________________ State ____________ Zip Code ___________________

Business Phone and Area Code (_____)__________________________________

Owner's Name ______________________________ Years in Business ________

Financial Credit References:

1.

Reference __________________________________________________________

Mailing Address ____________________________________________________

City _______________________ State __________ Zip Code _______________

2.

Reference __________________________________________________________

Mailing Address ____________________________________________________

City _______________________ State __________ Zip Code _______________

3.

Reference __________________________________________________________

Mailing Address ____________________________________________________

City _______________________ State __________ Zip Code _______________

Customers with whom you have done business:

Name _____________________________________________________________

Address _________________________________ Phone Number _____________

Name _____________________________________________________________

Address _________________________________ Phone Number _____________

Name _____________________________________________________________

Address _________________________________ Phone Number _____________

Your signature gives permission to check your financial references.

___________________________________________________ _____/_____/_____