Parker Lumber Company
P.O. Box 12463, Beaumont, Texas 77726-2463 (409) 898-7000 Fax (409) 347-0942
BUSINESS, COMMERCIAL and INDIVIDUAL CREDIT APPLICATION and AGREEMENT
TELL US ABOUT YOUR BUSINESS
Business Legal Name
Business Phone
Registered Company or DBA Name
Business Fax
Street Address
City
State
Zip
Mailing or Billing Address
City
State
Zip
Product/Service You Sell
Business Type □ Sole Proprietor □ Partnership □ Non-Profit
□ Farm □ Corporation □ Limited Liability Corporation □ Government
Month/Year Started
State Incorporated
Purchase Order Required?
□ Yes □ No
Federal Tax ID of SSN
Check One Tax ID (TIN)
□ EIN (Fed Tax) □ SSN
Credit Limit Desired
Accounts Payable Rep
Current Financial Statement Attached?
□ Yes □ No
Tax Exempt? Please Attach Certificate
□ Yes □ No
Store(s) to Charge At: □ Port Arthur □ Silsbee □ Orange □ Woodville □ Jasper Refugio
Hondo
□ Other
□Crystal Beach □ Shiner □ Sonora
AUTHORIZED SIGNERS
Name
Name
Name
Name
PRINCIPAL
Primary Signer Name (Owner/Partner/Officer)
Title
Home Phone
SSN
Home Address
City
State
Zip
Secondary Signer Name (Owner/Partner/Officer)
Title
Home Phone
SSN
Home Address
City
State
Zip
TRADE REFERENCES
Company Name
Business Phone
Business Fax
Company Name
Business Phone
Business Fax
Company Name
Business Phone
Business Fax
BANK REFERENCES
Bank Name
Account Number
Bank Phone
Bank Fax
Bank Name
Account Number
Bank Phone
Bank Fax
Most banks require your written authorization to release information on your banking relations. This information is necessary for us to complete your credit request
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