LAWRENCE RICCI INDUSTRIAL EQUIPMENT SERVICES CREDIT APPLICATION
Please enter the following information, print this page, then mail or fax to:
Lawrence Ricci Industrial Equipment Services
3740 Chicago Road
Steger, IL 60475
Phone: 708-756-2600
Fax: 708-756-2664
COMPANY
PHONE
FAX
EMAIL
BILLING ADDRESS:
ADDRESS
CITY
STATE
ZIP
COUNTRY
SHIPPING ADDRESS:
ADDRESS
CITY
STATE
ZIP
COUNTRY
DATE BUSINESS ESTABLISHED
AMOUNT OF CREDIT REQUIRED
  (If over $25,000, include current financial statement)
ARE YOU SALES TAX EXEMPT?
Yes
No   (If yes, please provide a copy of your Tax Exempt Cert.)
OWNERSHIP
Sole Ownership
Partnership
Corporation
FEDERAL ID #
DUNS #
OWNERS AND OFFICERS:
NAME
TITLE
ADDRESS
SOC. SEC. #
PHONE
NAME
TITLE
ADDRESS
SOC. SEC. #
PHONE
HAVE ANY OF THE ABOVE BEEN INVOLVED IN BANKRUPTCY
WITHIN THE LAST (10) TEN YEARS?
Yes
No
IF YES, UNDER WHAT NAME?
NAME
CITY
STATE
DISPOSITION
IF COMPANY IS LESS THAN (2) YEARS OLD, PROVIDE INFORMATION CONCERNING
PREVIOUS EMPLOYMENT OF PRINCIPLE OWNER(S):
COMPANY
TITLE
PHONE
COMPANY
TITLE
PHONE
COMPANY
TITLE
PHONE
LIST (3) THREE SUPPLIERS AND YOUR PRIMARY BANK (required information):
NAME
ADDRESS
PHONE
FAX
NAME
ADDRESS
PHONE
FAX
NAME
ADDRESS
PHONE
FAX
NAME
ADDRESS
PHONE
FAX