customer credit application form and agreement - Medline
customer credit application form and agreement - Medline
customer credit application form and agreement - Medline
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Bank Reference In<strong>form</strong>ation: Main Operating AccountName: Phone: Fax:Address: City ST ZipContact Name:Email Address: _________________________________________Authorization to Release Credit In<strong>form</strong>ationCompany Name(s) as appears on the Bank Account:I(Must be authorized signer for account)hereby authorize(Name of Bank)to release <strong>credit</strong> in<strong>form</strong>ation to MEDCAL SALES LLC (MEDLINE) for the purpose of establishing <strong>credit</strong> on thisday of , 20 .Please, release <strong>credit</strong> in<strong>form</strong>ation, using the <strong>form</strong> provided, on the following account type(s):Checking Account #Savings Account #Line(s) of Credit Account #Other Account #Please Sign Here:Date:(Person signing release <strong>form</strong> must be the authorized signer for the account(s).)All in<strong>form</strong>ation received is strictly confidential <strong>and</strong> is for <strong>Medline</strong>’s use only.3