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Credit Application
Name of Business/Individual:
Address:
City:
State:
Zip Code:
Mailing Address (if different):
Phone:
Type of Organization:
Corporation
Partnership
Sole Proprietor
Date Established:
Oregon Contractors License #:
Expiration Date:
Bond Company & Registration #:
New Field:
Name:
Position:
Address:
SS#:
Name:
Position:
Address:
SS#:
New Field:
Name:
Address:
Phone:
Name:
Address:
Phone:
Name:
Address:
Phone:
Name:
Address:
Phone:
New Field:
Bank Name:
Address:
Phone:
Contact Name:
New Field:
Signature:
Date:
Agreement Regarding Credit Terms
Date
Customer's Name:
Signature:
Title:
Personal Guarantee
Signature
Date
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Stayton Builders Mart
1080 Wilco Rd. /
PO Box 429
Stayton, OR 97383
(503) 769-7118
sbm@staytonbuildersmart.com
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