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  1. Which Hoffmann Brothers service are you needing credit for?(*)
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  2. Company Name(*)
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  3. Address(*)
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  4. City(*)
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  5. State(*)
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  6. Zip(*)
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  7. Phone(*)
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  8. Fax
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  9. Email(*)
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  10. Ownership(*)
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  11. Does the company require a purchase order?
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  12. Principals

  13. 1.
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  14. 2.
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  15. 3.
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  16.  

    FINANCIAL INFORMATION

  1. Bank(*)
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  2. Address
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  3. City
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  4. State
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  5. Zip
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  6. Phone Number
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  7. Checking ACCT #(*)
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  8. Saving ACCT #
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  9.  

    CREDIT REFERENCES

  1. 1.
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  2. PH #
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  3. Fax or Email
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  4. 2.
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  5. PH #
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  6. Fax or Email
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  7. 3.
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  8. PH #
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  9. Fax or Email
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  10. Contractee agrees to pay service charge of 1 1/2% per month (18% per year) on all past due invoices. Contractee agrees to pay all collection fees, legal fees, and expense's incurred by Hoffmann by connection with or in the collection of payment due.
    We certify that all the information on this form is correct. We fully understand your credit terms and agree to the proper payment in consideration of extended credit.
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  12. Name
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  13. Title
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