Company's name

Company's ss#

Company's address

Tel.

Fax.

Owner's name

E-mail

Complete the following information
for the commercial references

Name

Mailing Address

Tel.

Name

Mailing Address

Tel.

Name

Mailing Address

Tel.

Complete the following if your
company is NOT incorporated.

Physical address

Owner's SS#

Owner' Tel.

Requested credit line

Requested terms

Bank references

Bank's name

Account #

Bank's name

Account #

Bank credit Information
release authorization

Do you accept this as an autorization
to disclose to Archilla Paper Corporation
the customary information you
would normally release to a
prospective creditor including :

• Lenght of time account has been active
• Average monthly balances
• How the account has been handled
• Details of any lending relationship

i accept