P.O. Box 97, 15981 Valplast Road, Middlefield, OH 44062 USA • 440-632-1631
Please complete in entirety
CONFIDENTIAL NEW ACCOUNT APPLICATION
FAX: 440-632-1581
Credit Line Requested $
Company Name
Trading As
Address
P.O. Box
City
State/Province
Country
Postal Code
Telephone No
Fax No
If applicable: Include Country & City Codes
E-mail
Principal, Title
SS#
Principal, Title
SS#
Type of Business
Year Started
Fed ID #
Resale #
Sales Tax Exempt #
* We will need a copy of the certificates for our files
Ownership
Proprietorship
Partnership
Incorporated
Year and State
Incorporated In
Number of Locations
Number of Employees
Annual Sales $
Financial Statement
To follow by fax
Attached
Will be mailed separately
Financial Contact
Phone Number
Buyer
Phone Number
US TRADE REFERENCES
Name of Company/Contact
Complete Address
Phone/Fax Number
Account Number
1.
P: F:
2.
P: F:
3.
P: F:
Bank Name
Account No.
Bank Address
Principal's Authorization/Signature
Date
Privacy Policy
Copyright © 2003 Duncan Toys Company All rights reserved
To be completed by Credit and Customer Services
Division
Customer #
Cash Terms
Credit Line
D&B #
Credit Specialist
Date
Preferred Carrier
Freight Terms
Sales Approval:
Representative
Rep Code
Date
Corporate Credit Manager
Date