AEROMECH, INC.
3454 AIRFIELD DR WEST
LAKELAND, FL 33811
PHONE: 863-619-8133
FAX: 863-648-5688
APPLICATION FOR CREDIT
DATE_________________
COMPANY OR INDIVIDUAL NAME_________________________________________________________
ADDRESS________________________________________________________________________________
PHONE________________________FAX____________________________E-MAIL____________________
OFFICERS_______________________________________________________________________________
BUSINESS INFORMATION
TYPE _______________DATE STARTED_______________INC
IN THE STATE OF__________________
FEDERAL I.D.#_____________________RESALE
TAX #(If Tax Exempt)__________________________
BANK INFORMATION
NAME____________________________________________________________________________________
ADDRESS________________________________________________________________________________
CONTACT NAME AND PHONE_____________________________________________________________
ACCOUNT #____________________________________
TRADE REFERENCES (PLEASE LIST THREE)
NAME____________________________________________________________________________________
ADDRESS________________________________________________________________________________
PHONE AND FAX #________________________________________________________________________
NAME____________________________________________________________________________________
ADDRESS________________________________________________________________________________
PHONE AND FAX #________________________________________________________________________
NAME____________________________________________________________________________________
ADDRESS________________________________________________________________________________
PHONE AND FAX #________________________________________________________________________
SIGNATURE_________________________________
TITLE______________________________________