| COMPANY
NAME____________________________________________________________
ADDRESS___________________________________________________________________
PHONE______________ FAX____________ |
| CONTACT (NAME OF
BUYER)________________________________________________ |
|
|
|
| NAME, ADDRESS, PHONE NUMBERS, AND TITLES OF
INDIVIDUALS, PARTNERS, AND CORPORATE OFFICERS: |
|
| ____________________________________________________________________________ |
|
| ____________________________________________________________________________ |
|
| ____________________________________________________________________________ |
|
|
|
| BANK REFERENCES: |
|
| 1) BANK
NAME/ADDRESS/TELEPHONE#______________________________________ |
|
| ___________________________________________________________________________ |
|
| TYPE OF
ACCOUNT_________________________________________________________ |
|
|
|
| 2) BANK
NAME/ADDRESS/TELEPHONE#______________________________________ |
|
| ___________________________________________________________________________ |
|
| TYPE OF
ACCOUNT_________________________________________________________ |
|
|
|
|
|
| TRADE REFERENCES: |
|
| 1) COMPANY NAME/ADDRESS/TELEPHONE
#_________________________________ |
|
| ___________________________________________________________________________ |
|
| ___________________________________________________________________________ |
|
| 2) COMPANY NAME/ADDRESS/TELEPHONE
#_________________________________ |
|
| ___________________________________________________________________________ |
|
| ___________________________________________________________________________ |
|
| 3) COMPANY NAME/ADDRESS/TELEPHONE
#_________________________________ |
|
| ___________________________________________________________________________ |
|
| ___________________________________________________________________________ |
|