10950 Linpage Place St. Louis, MO 63132 PH: 314-241-1214 FX: 314-241-2277 www.hy-c.com
Section 2: Line of Credit Request
Requested Credit limit:
Requesting Credit line? No (skip this page) Yes (fill out this page)
Please provide references which meet the following criteria: • Applicant is currently doing business with or has done business within the last three (3) years. • Credit lines similar to the $ volume as requested with this application. • Do NOT submit references that applicant does NOT want HY-C to notify of Application for Account. • Accurate information will expedite the processing of your application . Please verify contact #’s & email addresses. Applicants may elect to contact the Supplier to encourage their response in a timely manner. Bank Reference Bank Name Name of Officer/Contact:
Street Address:
Email Address:
Mailing Address: (if different)
Phone #:
Fax #:
City, State
Postal Code
Account Type:
Account #:
Supplier Reference #1
Company Name
Name of Contact
Street Address:
Email Address:
Mailing Address: (if different)
Phone #:
Fax #:
City, State
Postal Code
Account #:
Supplier Reference #2
Company Name
Name of Contact
Street Address:
Email Address:
Mailing Address: (if different)
Phone #:
Fax #:
City, State
Postal Code
Account #:
Supplier Reference #3
Company Name
Name of Contact
Street Address:
Email Address:
Mailing Address: (if different)
Phone #:
Fax #:
City, State
Postal Code
Account #:
Made with FlippingBook - professional solution for displaying marketing and sales documents online