Unitex International, Inc.

2855 N Berkeley Lake Rd NW
Duluth, GA 30096

Toll Free: (888) 4-UNITEX ..... Local: (770) 232-0060	Contact Us

ONLINE APPLICATION FORM

Thank you for your interest obtaining an open credit account with Unitex International, Inc. Please fill out the form below. All information provided is kept confidential.

Completely fill out this application and hit the SUBMIT button -- information will be deleted unless SUBMIT is clicked before browsing other pages.

Required fields are noted in red.

Business Information

Business Name
Customer No:
Address

City
State
Zip Code
Phone
Fax
First Name
Last Name
E-Mail
E-Mail
Business Type	Self Owned Limited Partnership Corporation General Partnership Other, specify:
Incorporate in State of
Tax Exempt - Date Began
Please fax your tax exempt certificate to 678/377-8381.
Owner/Operator Information
1. Names of owner(s), general partners, or stockholders: Owner General Partner Principal Stockholder
Name
Title
Ownership Since
Social Security No.
Address

City
State
Zip Code
Phone
Fax
2. Names of owner(s), general partners, or stockholders: Owner General Partner Principal Stockholder
Name
Title
Ownership Since
Social Security No.
Address

City
State
Zip Code
Phone
Fax
Property owned or operated in the name of the above:
Property Name
Name of Manager
Address

City
State
Zip Code
Phone
Fax
Credit Information
Credit Card Type
Card Number
Exp Date
Name on Account
Issuing Bank
Address

City
State
Zip Code
If payment is not made according to agreed upon terms, it will be charged to the above charge account.
Credit References List below your primary bank account and at least 3 active credit references.
PRIMARY BANK ACCOUNT
Bank Name
Address

City
State
Zip Code
Account #
Phone
CREDIT REFERENCE 1
Credit Reference
Address

City
State
Zip Code
Account #
Phone
CREDIT REFERENCE 2
Credit Reference
Address

City
State
Zip Code
Account #
Phone
CREDIT REFERENCE 3
Credit Reference
Address

City
State
Zip Code
Account #
Phone
Amount of Credit Requested
Amount Requesting
In consideration of any extension of credit granted by Unitex International Inc., the undersigned and business (property) hereby agree to pay all costs up to and including any legal fees that may be required to collect any money owed to us as an uncollected debt. By submitting the application, the applicant agrees and accepts all terms and conditions and understands that all information provided is correct and accurate to the best of their knowledge. By submitting the application, the applicant also authorizes Unitex International, Inc. to check with the listed credit references.

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