Date

BUSINESS INFORMATION

Company Name			Tax ID or Social Security #
Contact			Title
Address			City
State			Zip
Telephone			Fax
Mobile			Email
Type of Business			Date Business Established
REFERENCES
Please list 3 active sources. References submitted without account numbers will not be considered
Company Name			Address
City, State			Zip
Account #			Telephone
Company Name			Address
City, State			Zip
Account #			Telephone
Company Name			Address
City, State			Zip
Account #			Telephone
CREDIT INFORMATION RELEASE AUTHORIZATION
It is understood and agreed that, Taffard Fabrics, Inc. may contact any of the above references, as well as business and consumer reporting agencies for the purpose of establishing credit terms or updating the customers credit file.