Credit Application - E.J. Prescott

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Credit Application - Part 1 of 5

* = required

New Account Information

Company name *
Mailing address *
City *
State *
Zip code *
Enter seperate address for shipping

Shipping address
City
State
Zip

Telephone *
Fax *
Contact person *
Email address *
Name of accounts payable representative *

General Information

Type of organization *
Type of business *
Taxable *	Yes No Sometimes
Nearest ejp location *

EJ Prescott - Steve Prescott