Credit Application
We request the extension of credit for the purpose of conducting business with:
Brunner Enterprises Inc. 455 Center Road, West Seneca (Buffalo), NY 14224
Phone: 716-712-0180 Fax: 716-712-0183 Toll Free: 877-299-2622
 

Company Full Legal Name

Billing Address

City / Town                                                           State                      ZIP                                     Phone

Check One:               Sole Proprietor   __        Partnership  __     Corporation  __
We Are applying for credit in the amount of: $________________
Please supply information on Bank & Credit relationships in the following part of this form:

Principal Bank Relationship

Bank Name & Address

Officer to contact                                                          Branch                                                         Phone

Credit Relationships

Company (1)                                                                   Address

Credit contact (1)                                                              Phone                                                       Fax  (required)

Company (2)                                                                   Address

Credit contact (2)                                                              Phone                                                       Fax  (required)  

Company (3)                                                                   Address

Credit contact (3)                                                              Phone                                                       Fax  (required)  

Principals of Company Requesting Credit 
 

Name                                                                               Address

Name                                                                               Address

We understand that the credit terms of Brunner Enterprises Inc. are net upon receipt of invoice and that any amounts not paid within 30 days from date of invoice will be subject to a 1% per month charge and may be grounds for refusal of future credit.