THIS IS NOT AN ONLINE FORM; PLEASE PRINT AND FAX OR MAIL TO US Diamondhead USA, Inc. E-Mail: Sales@Diamondhead-USA.com Fax: (413) 739-6973 Credit Application for a Business Account
Business Contact Information
Company name:
Contact name:
Phone:	Fax:			E-mail:
Registered company address:
City:				State:					ZIP Code:
Date business commenced:
Sole proprietorship:		Partnership:		Corporation:					Other:
Business and Credit Information
Primary business address:
City:					State:				ZIP Code:
How long at current address?					Website:
Telephone:			Fax:			E-mail:
Bank name:
Bank address:							Phone:
City:							State:		ZIP Code:
Type of account:							Account number:
Savings:							Checking
Years in operation							2009 Sales
Major markets:							Est. Monthly Sales
Customers:
Business/trade references
Company name:
Address:
City:						State:			ZIP Code:
Phone:	Fax:					E-mail:
Type of account:
Company name:
Address:
City:						State:			ZIP Code:
Phone:	Fax:					E-mail:
Type of account:
Company name:
Address:
City:						State:			ZIP Code:
Phone:	Fax:					E-mail:
Type of account:
Agreement
All invoices are to be paid as stated in the Agreement once credit has been approved. By submitting this application, you authorize Diamondhead-USA, Inc. to make enquiries into the banking and business/trade references you have supplied. Support documents required are FFL, Sales tax and resale certificate, Business License, Proof of advertising, State ID.
Signatures
Title: Date:								Title: Date: