Optimum Source Credit Application

CUSTOMER CONTRACT (pdf)
Please click above to access the Customer Contract.
Print it out and FAX it back to 978-453-5211.

COMPANY INFORMATION Legal Firm Name Additional Trade Name Address City State Zip Business Phone Fax Payables Contact IRS Employer ID# Type of Business Corporation Partnership Proprietorship Limited Partnership Other Date Established (M/D/Y) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Incorporated: State/Year Has present firm ever done business under other names or other address? If so, please list. PRINCIPAL OFFICERS/OWNERS/PARTNERS Name Title Name Title BANK REFERENCES Bank Name Address City State Zip Phone Fax ACCOUNTS Checking # Loan # Savings # Bank Contact TRADE REFERENCES Firm Name Contact Address City State Zip Phone Fax High Credit $ Annual Purchase $ Firm Name Contact Address City State Zip Phone Fax High Credit $ Annual Purchase $ SUBMITTER INFORMATION Submitted By Title Date 11/20/2008