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Credit Application

Name:

Title:

Company:

Address:

City:

State:

Zip:

Email:

Tel:

Fax:

Bank Reference:

Bank Name:

Phone:

Fax:

Account #:

Trade Reference:

Firm Name:

Phone:

Fax:

Account #:

Trade Reference:

Firm Name:

Phone:

Fax:

Account #:

Trade Reference:

Firm Name:

Phone:

Fax:

Account #:

We certify that all information on this form is correct; and that we fully understand your credit terms and agree to the proper payment in consideration for extended credit. In addition, our signature authorizes release of credit information to Accurate Forklift.

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