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Credit Account Application


Please print out this form, fill it out completely, and sign all appropriate sections. Included is a credit agreement which must be signed, along with the personal guarantee which also must be completed for any account that is a Corporation. Mail to:

I. D. Booth Inc / Booth Electrical Supply
Wholesalers
620 William Street, P.O. Box 579
Elmira, NY 14902-0579


ACCOUNT INFORMATION:

Individual/Business Name:
Street & Box Address:
City/County:
State & Zip Code:
Mailing Address:
City/County:
State & Zip Code:
Business Phone:
Fax Number:
Pager Number:
Cell Phone Number:
Federal ID Number:
Social Security Number:
YOUR COMPANY'S INFORMATION:

Type of Business:
Years in Business:
Please check that applies: Proprietorship ____      Partnership____      Corporation____
Number of Employees:_____      Work is conducted from home____      Shop____
 

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