Business Credit Form

CREDIT APPLICATION

MARTINEZ DISTRIBUTORS CORP - 7379 NW 31 ST, MIAMI, FL, 33122

Today's Date:

If you wish to edit your already sent application please

Company Info

Trade References

Business Information

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Company Info

Sales Rep Name

Corporation Name *

Dba *

Bill to Address *

City *

State *

Zip *

Ship to Name

Ship to Address *

City *

State *

Zip *

Business Phone *

Tax ID *

Beverage License Number *

Date *

Owner Name *

Owner Driver's License # *

Individual Personal Guarantee

in consideration of Martinez Distributors Company, extending credit at my request on

, of which I am owner.

Trade References

Landlord Name *

Phone Landlord *

Ref 1 Company Name *

Ref 1 Phone Company *

Ref 2 Company Name *

Ref 2 Phone Company *

Business Information

Website Address *

Owner Information

Owner Name *

Cell phone Number *

Home Address *

City *

State *

Zip *

House phone Number

Email Address *

Account Payable Information

Payable Name *

Cell phone Number *

Email Address *

Buyer Information

Buyer Name *

Cell phone Number *

Email Address *

Upload File + Email Receive

Email to receive the form you must sign. *

Upload Driver License or Florida ID of Owner and Copy of Company Resale Certificate if Applicable

CREDIT APPLICATION

Company Info

Trade References

Business Information

Upload File + Email Receive

Review & Confirm