Magnolia Paper & Janitor Supply--Credit Application

MAGNOLIA PAPER & JANITOR SUPPLY
P.O. BOX 770360, MEMPHIS, TN 38177-0360
PHONE: 901-683-5796 FAX: 901-683-2690
EMAIL ADDRESS: ar@magnoliapaper.net

LOCATION ADDRESS

Customer's Exact Name: ____________________________________________

Trade or Business Name: ____________________________________________

Street/P.O. Box: ____________________________________________

City, State, Zip: ____________________________________________

Telephone Number: ____________________________________________

Fax Number: ____________________________________________

Email Address: ____________________________________________

MAILING ADDRESS

Street/P.O. Box: ____________________________________________

City, State, Zip: ____________________________________________

OWNER INFORMATION

Owner of Premises: ____________________________________________

Type of Business: ____________________________________________
(Individual, Partnership, or Corporation)

Individual Owner(s) or Partner(s): ____________________________________________

OTHER INFORMATION

Social Security Numbers: ____________________________________________

Driver's License Numbers: ____________________________________________

Managing Partner: ____________________________________________

Corporate President: ____________________________________________

Corporate Secretary: ____________________________________________

Federal Employer ID#: ____________________________________________

State Revenue ID#: ____________________________________________

Tennessee Resale Sales Tax#: ____________________________________________

Tennessee Nonprofit Tax#: ____________________________________________

How Long in Business: ____________________________________________

Prior Business Name
(If Any): ____________________________________________

Party Responsible for Payment of Purchase
(Full Name): ____________________________________________

BANK REFERENCES

Bank Name: ____________________________________________

Bank Address: ____________________________________________

Phone Number: ____________________________________________

Account Officer: ____________________________________________

Bank Account Number: ____________________________________________

IF HOTEL, MOTEL, OR APARTMENT

1. Is Purchaser a Management Firm, Only? _______________________________

2. Address of Home Office: _______________________________

3. Employer of Management Firm: _______________________________

We are authorizing you to contact the references provided in order to obtain
the proper information to consider granting credit privileges to us:

CREDIT REFERENCES
(Company Name, Address, & Telephone Number)

1. _________________________________________________________________

2. _________________________________________________________________

3. _________________________________________________________________

Purchaser agrees to service charge on 1 1/2% to be charged monthly on the
balance owed on this account if account is not paid within 30 days from date
of invoice. Purchaser also agrees to pay all attorney's fees, court costs &
all other costs which may be incurred by Magnolia Paper & Janitor Supply
Co., Inc. In the collection of this account until said account is paid in full.

________________________________
Purchaser ________________________________
Sales Person

________________________________
Authorized Signature & Date ________________________________
Approved Or Rejected

________________________________
Print Same As Signature ________________________________
Sales Manager & Date

Customer's Exact Name:	____________________________________________
Trade or Business Name:	____________________________________________
Street/P.O. Box:	____________________________________________
City, State, Zip:	____________________________________________
Telephone Number:	____________________________________________
Fax Number:	____________________________________________
Email Address:	____________________________________________

Owner of Premises:	____________________________________________
Type of Business:	____________________________________________ (Individual, Partnership, or Corporation)
Individual Owner(s) or Partner(s):	____________________________________________

Social Security Numbers:	____________________________________________
Driver's License Numbers:	____________________________________________
Managing Partner:	____________________________________________
Corporate President:	____________________________________________
Corporate Secretary:	____________________________________________
Federal Employer ID#:	____________________________________________
State Revenue ID#:	____________________________________________
Tennessee Resale Sales Tax#:	____________________________________________
Tennessee Nonprofit Tax#:	____________________________________________
How Long in Business:	____________________________________________
Prior Business Name (If Any):	____________________________________________
Party Responsible for Payment of Purchase (Full Name):	____________________________________________

Bank Name:	____________________________________________
Bank Address:	____________________________________________
Phone Number:	____________________________________________
Account Officer:	____________________________________________
Bank Account Number:	____________________________________________

1. Is Purchaser a Management Firm, Only?	_______________________________
2. Address of Home Office:	_______________________________
3. Employer of Management Firm:	_______________________________

________________________________ Purchaser	________________________________ Sales Person
________________________________ Authorized Signature & Date	________________________________ Approved Or Rejected
________________________________ Print Same As Signature	________________________________ Sales Manager & Date