American Home Rug Company - Dealer Application Form


AMERICAN HOME RUG COMPANY

Online Credit Application and Purchase Agreement
For valuable consideration recieved and in order to induce American Home Rug Co., Inc. to extend credit to:
 Legal Company Name(hereinafter referred to as Company):
           
 Legal Company Address:
 Street: 
City  State  Zip  Tel
Fax:  * E-Mail: 
Legal Company Status:
Inc.     Partnership     Ownership      Other 
If Other, please explain: 
Bank Name:
    Account#: 
City  State  Zip  Tel
Are you listed with Dunn & Bradstreet?:      If yes, Rating: 
Trade References:
Provide 3 references with which you have conducted business in the past 2 years:
(1): Address: 
City  State  Zip  Tel
(2): Address: 
City  State  Zip  Tel
(3): Address: 
City  State  Zip  Tel
Principals of the Company:
(1):  Pos:  Tel:
(2):  Pos:  Tel:
Undersigned for:
  Title:   Date:
Business Name:
Phone: 
Special Requirements or Considerations (This field is Optional):

Please submit form only once!
American Home Rugs  •  Main & State Streets  •  Doylestown, PA 18901
FAX: 215-348-9056    

Please email questions regarding Dealer Application.