Oxbo Application Form



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Confidential Credit Application
If your firm does not have credit established with Oxbo International Corporation, please complete all fields.

Company Information
Date:			Legal Company Name:
Street Address:			Address 2 :
City:			State or Prov:
Zip/Postal:			Country:
Phone:			Email:
Shipping Information
Shipping Address:			Shipping Address 2:
City:			State or Prov:
Zip/Postal:			Country:
Business Information
Year Bus. Started:			Year Bus. Inc:
Annual Sales $:			# of Employees:
Amount of Credit Desired $:
Bank References
	Firm Name:	Account #:	Contact:	Phone:	Fax:
1.
	Address:	City:	State/Prov:	Zip:	Country:

	Firm Name:	Account #:	Contact:	Phone:	Fax:
2.
	Address:	City:	State/Prov:	Zip:	Country:

	Firm Name:	Account #:	Contact:	Phone:	Fax:
3.
	Address:	City:	State/Prov:	Zip:	Country:

Business Structure:
Trade References
All three spaces must be filled in with current open account creditors that allow your firm to purchase $1,000.00 or more, within the last 12 months.
	Firm Name:	Contact:	Phone:	Fax:
1.
	Address:	City:	State/Prov:	Zip:

	Firm Name:	Contact:	Phone:	Fax:
2.
	Address:	City:	State/Prov:	Zip:

	Firm Name:	Contact:	Phone:	Fax:
3.
	Address:	City:	State/Prov:	Zip:

Company Principals Responsible for Business Transactions
Name:			c/o ownership:	Position:
Name:			c/o ownership:	Position:
Name:			c/o ownership:	Position:

This application is given for the sole purpose of establishing credit with Oxbo International Corporation. I/We authorize our creditors and other parties given above, to release information to representatives of Oxbo International Corporation. I/We agree to pay all invoices in accordance with the terms of sale shown on such invoice and statements provided. I/We agree to pay interest charges on al balances and/or amounts that are past due as set by Oxbo international Corporation at the legal rate allowed by law. I/We will also agree to pay all collection costs, including but not limited to attorney fee and court costs, incurred by Oxbo International Corporation to collect monies owed.
Signature:			Title:
Date: