Commercial Credit Application - Keystone Container Service

Company Name*

Address*

Street Address Address Line 2 City State ZIP Code

Company Type*

Phone*

Contact*

Sales Tax Exempt?*

Sales Tax Exempt Number*

Please Attach Copy of Certificate

Accepted file types: jpg, png, pdf, Max. file size: 10 MB.

Federal ID #*

PRINCIPAL OWNERS

Name

Title

Name

Title

Name

Title

CREDIT REFERENCES

Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

BANK REFERENCES

Name

Phone

Address

Street Address Address Line 2 City State ZIP Code

Account Number*

Contact

This information contained in this application and all financial date submitted in connection herewith is for the purpose of obtaining credit and is represented by the application to be true and complete. The applicant authorizes Keystone Container Service, Inc. to investigate all credit references and any other matters pertaining to its financial responsibility. Should credit be granted, the applicant agrees to pay Keystone Container Service, Inc. interest on overdue accounts at the rate of one and one-half percent (1-1/2%) per month. This agreement must be signed by a corporate officer, partner, or owner.

Signature*

Title*

(570) 969-2400 | Toll Free 1-888-969-2400 | Fax (570) 344-8280
P. O. Box 2 - Dunmore, PA 18512

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