Gem State Paper & Supply

PRODUCT CATALOG

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Dear Customer: We will appreciate basic financial information so that we may document our records and also to be used as a basis of credit extension of you. This information will be held in strict confidence. A credit report will be pulled & application must be signed. Name of Business Mailing Address Delivery Address City State Zip Business Phone In this Business? Home Phone At this Location? Fax Number E-mail Address Credit Requested: $ Type of Business If Incorporated, in what State Owners Owner's Address Previous Address Principal Stockholders If Subsidiary, Name of Parent Co. Address Billing Address Billing Instructions Authorized Buyer Name of Officer to Contact for Further Credit Information ❑ Sole Proprietor ❑ Subsidiary Corp ❑ Partnership ❑ Government Agency ❑ Corporation ❑ Govt. Funded Project ❑ Own Do you ❑ Rent ❑ Lease, How long How Many Years Approximate If less than 6 Mos., (NAME) (CITY) (STATE) (SOCIAL SECURITY NO.) (SOCIAL SECURITY NO.) (SOCIAL SECURITY NO.) (SOCIAL SECURITY NO.) (PHONE) (PHONE) (PHONE) (ZIP) (ZIP) (ZIP) (ZIP) (STATE) (STATE) (STATE) (TITLE) (TITLE) (TITLE) (TITLE) (TITLE) (CITY) (CITY) (CITY) (NAME) (NAME) (NAME) (NAME) (NAME) OFFICE USE ONLY ACC NO. SLSM SALES TAX NO. CRLMT ENTERED CREDIT APPROVED BY: DATE P.O. BOX 469 • TWIN FALLS, IDAHO 83303-0469 1-208-733-6081 • 1-800-727-2737 • FAX 1-208-734-9870 Customer Application

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