COMPANY INFORMATION

Business Name:

Streeet Address:
City:
State:
Zip Code:
Phone:
Fax:
email:
Type of business:
 Sole-Propietorship
Partnership
Corporation
Other
Year Established:
           
OWNER / OFFICER INFORMATION
Name: Title:
Home Address:
City:
State:
Zip Code:
.
Name: Title:
Home Address:
City:
State:
Zip Code:
BANK INFORMATION
Bank Name:
Phone:
Account Number:
 Fax:
TRADE REFERENCES
1. Company Name: Phone Number:
Account Number: Fax Number:
2. Company Name: Phone Number:
Account Number: Fax Number:
3. Company Name: Phone Number:
Account Number: Fax Number:
APPLICANT AND CO-SIGNER NAMES
Applicant's Name: Co-Signer's Name:
Please print and: fax or mail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3607 Washington Street, Boston, MA 02130
Tel (617) 983 9920 : 1 800 244 1656
Fax (617) 983 9918
fhelectrical@fhelectrical.com