BR-1 AMERICA

ACCOUNT OPENING APPLICATION

  • BR-1 Salesperson：
  • For the purpose of establishing an account with BR-1 America, Inc., I/We, undersigned, warrant the information below to be true, correct and complete to the best of my/our knowledge and hereby authorizes any creditor, bank, lending institution, or any other reference listed herein to furnish BR-1 America, Inc. with any and all information requested.
  • Date：

  • Phone：
  • Fax：
  • Proprietorship Partnership Corporation EIN#：
  • Date Established：
  • (Please attach a copy of Certificate of Sales tax registration)
  • 　　　
  • Has applicant or any of the Principals filed for Bankruptcy in the last seven years? Yes No
  • Name and Addresses of Principals:
  • Title：
  • %
  • Social Security #：
  • Title：
  • %
  • Social Security #：
  • Bank References
  • Officer’s Name：
  • Phone：
  • Officer’s Name：
  • Phone：
  • Business References
  • Account Number： Contact：
  • Credit Unit：
  • Account Number： Contact：
  • Credit Unit：
  • Account Number： Contact：
  • Credit Unit：
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