Step 1 of 333%GENERAL INFORMATIONName Of Company*DBABilling AddressCityStateZipShipping Address*CityStateZipTelephone No.*Fax No.Line Of Credit RequestedE Mail Address* REFERENCESBankBankAccount No.AddressCityStateZipTelephone No.Fax No.Trade # 1CompanyAccount NoAddressCityStateZipTelephone NoFax No.Trade # 2CompanyAccount NoAddressCityStateZipTelephone NoFax No.Trade # 3CompanyAccount NoAddressCityStateZipTelephone NoFax No.* I Authorize The Above Listed Bank And Trade References To Release Information Necessary To Establish A Charge Account With Johnson Corporation : Johnson & Towers Inc., Johnson Truck Center, LlcCOMPANY BACKGROUNDType Of BusinessSS OR EIN #No. Of Years In BusinessYears Under Present Mgmt.Are P.O.'s Required?YesNoType Of Company:ProprietorshipPartnershipCorporationTax StatusTaxableExemptOwners, Partners Or Corporate OfficersNameAddressCityStateZipNameAddressCityStateZipNameAddressCityStateZipA/P ContactNamePhone No.Fax No.Shop ContactNamePhone No.Fax No.Purch. AgentNamePhone No.Fax No.
