The largest Wholesale distributor for dollar store products and general merchandise!

Enterprises, Inc.

(323)CONCORD

(800)960-0896

(323)588-8888

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Credit Application:

Fill in the form, Print it, Sign and Fax it to (323) 588-8080

Company Name:
First & Last Name:
Company Type:	Sole Partnership Corporation Proprietorship
How long in business?	years
Address1:
Address2:
City:
State:
Zip Code:
Country:
Company Phone:
Company Fax:
Principal's:
Home Address1:
Home Address2:
City:
State:
Zip Code:
Country:
Home Phone:
Home Fax:
Driver's License #:
State:
Social Security #:	- -
Bank Information
Bank Name:
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Account #:
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Bank Contact Name:
Business References
Name:
Address1:
Address2:
City:
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Zip Code:
Country:
Contact:
Phone:
Fax:

Name:
Address1:
Address2:
City:
State:
Zip Code:
Country:
Contact:
Phone:
Fax:

Name:
Address1:
Address2:
City:
State:
Zip Code:
Country:
Contact:
Phone:
Fax:

Name:
Address1:
Address2:
City:
State:
Zip Code:
Country:
Contact:
Phone:
Fax:
In the event of a past due account, I (we) hereby agree to pay 2% per month late payment service charge and if legal action becomes necessary to collect the indebtedness, I (we) further agree to pay all attorney fees, collection costs, and court fees, in addition to the principal amount due. I (we) authorize Concord Enterprises to obtain credit information from any person, entity, credit agencies, banks, etc.
Title: _________ Signature: _____________________ Date: ___/___/____

Address: 2957 E. 46 ST. Los Angeles, California 90058 U.S.A. Tel(323)588-8888 (323)CONCORD Fax(323)588-8080
Tol Free(800)960-0896
Email: sales@dollaritem.com
Â© 1982 Concord Enterprises, Inc. All rights reserved.