Print Page 1     ---   1 2 3 4

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 and LLC. 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:
Email:
Cell Phone Number:
Federal ID Number:
Social Security Number:
Salesperson Referral:
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____
 

Next Page >>