BARRETO ONLINE FORMS

Customer Credit Application

Please fill out the following information as completely and thoroughly as possible. Once finished, please authorize Barreto Manufacturing, Inc. to investigate the references submitted in this form by clicking the "I agree" submit button at the bottom of this form. Thank you.

All fields in red are required

Credit Application

Name of Business:
Years in Business:
Mailing Address:
City:
State:
ZIP:
Phone:
Fax:

Company Information

President or Owner:
E-mail Address:
Federal ID Number:
Social Security Number:
Sales Manager:
Accounting Manager:

Bank Information

Bank Reference:
Account Number:
Address:
City:
State:
ZIP:
Phone:
Fax:

United States Trade References (Major Suppliers)

Trade Reference 1

Name:
Account Number:
Address:
City:
State:
ZIP:
Phone:
Fax:

Trade Reference 2

Name:
Account Number:
Address:
City:
State:
ZIP:
Phone:
Fax:

Trade Reference 3

Name:
Account Number:
Address:
City:
State:
ZIP:
Phone:
Fax:

Trade Reference 4

Name:
Account Number:
Address:
City:
State:
ZIP:
Phone:
Fax:

Trade Reference 5

Name:
Account Number:
Address:
City:
State:
ZIP:
Phone:
Fax:

Terms and Conditions

2% 15 Days, Net 30 Days - 2% Finance Charge is added to all past due accounts. Finance Charge MUST be paid to keep the account in good dstanding. Minumum finance charge is $2.50. Purchaser agrees to pay attorney's fees, court costs and all expenses involved in the event legal action is necessary for the collection of outstanding charges. Note: Discounts may be taken only if account is current.

Agreement

I/We have made application to BARRETO MANUFACTURING, INC., La Grande, Oregon, for "Open Account" shipping of the product line they manufacture and distribute. In this regard, I/We authorize BARRETO MANUFACTURING to investigate the references submitted and our references to release information pertaining to my/our credit and financial responsibility.

By clicking the "I agree" button below, you agree to the credit terms and conditions as well as the terms in the agreement in the paragraph above.