Credit Application

Customer Information

* = Mandatory

Sales Representative: *

Company Name: *

Billing Address: *

City: *

State: *

Zip: *

Phone: *

Fax:

Buyer: *

Phone: *

Email:

Accounts Payable: *

Phone: *

Email:

Resale Number: *

Business Type

Sole Proprietor

LLC

Limited Partnership

S Corp

General Partnership

C Corp

A minimum of one reference is required.

References

Company Name: *

Contact:

Address: *

Phone: *

Fax:

Company Name:

Contact:

Address:

Phone:

Fax:

Company Name:

Contact:

Address:

Phone:

Fax:

Company Name:

Contact:

Address:

Phone:

Fax:

Terms of Agreement

By submitting this Application, you grant consent to and authorize Uplift Cabinets and its agents to obtain commercial credit reports and make other credit inquiries that it determines necessary. You also warrant the information on or accompanying this Application is true and complete, and you agree to notify Uplift Cabinets of any material change in any such information. You authorize Uplift Cabinets and any credit bureau or investigative agency to investigate the references, statements, and other data on or accompanying this Application, and you authorize anybody contacted to release credit and financial information requested as part of the investigation.

I, * , agree to the terms of this contract and by marking this checkbox I am digitally signing this contract.

Contact

info@upliftcabinets.com
40 SE 7TH St
Boca Raton, FL 33432
Tel. 561-417-2507
Fax 561-417-0039

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