APPLICATION FOR COMMERCIAL CHARGE ACCOUNT Waterman Broadcasting Corp.
P.O. Box 7578
Fort Myers, FL 33911-7578
Erica Scalise
Office: 939-2020 x329
Fax: (239) 939-9025
Date: ______________________ Account Executive: Erica Scalise
Company Name: ______________________________ Street Address: ___________________________________
Company DBA Business Name: ________________________________________
City: ____________________________ State: _________    Zip Code: ________ Phone Number: _______________
Type of Business: __________________________________ Corporation Co. Partnership Limited Partnership Individual Proprietor
No. Years Established
___________________		 Federal Tax I.D.
____________________		 Est. Air Date:
_____________________		 Monthly Credit Desired:
______________________
If a branch office or
a division, give name    ______________________________
of parent company
and home office            ______________________________		 Where should            ____________________________________
invoices be mailed:
                              _____________________________________
PRINCIPAL OWNERS - STOCKHOLDERS - PARTNERS - OFFICERS OF COMPANY
Name Social Security # Mailing Address City State Zip Title
             
             
             
LIST PERSONS AUTHORIZED BY YOUR COMPANY TO MAKE PURCHASES
1. _____________________ 2. _____________________ 3. _____________________ 4. _____________________
BUSINESS REFERENCES
Name Address City State Zip Phone #
           
           
           
BANK REFERENCES
Bank Name Address City State Zip Phone # Account Number
             
             

I, the undersigned person, personally guarantee the payment of all sums that become due by the company. Including court costs, collection costs and reasonable attorney's fees in the event of default. I understand that all charges on my account are due and payable within 30 days.

Authorized Signature ____________________________________________________

FOR CREDIT DEPARTMENT USE ONLY
Approved
Rejected 		Credit Limit $ ___________________
By ___________________________		 Remarks: _________________________
__________________________________