Capri Farms Credit Application Capri Farms Credit Application Company Name(required) Buyer/Contact Name(required) Telephone(required) Fax(required) Email(required) Website Bill To Address(required) City(required) State(required) Zip Code(required) Type of Business (Check One)(required) Wholesale Retail Broker Grower Interiorscape Garden Center Ownership (Check One)(required) Sole Proprietorship Partnership Corporation Proprietor or Principal Officer Title Federal ID # Year Established Amount of Credit Required $ Estimated Net Worth $ Bank & Acct # 1 ) Name Address Telephone Fax 2 ) Name Address Telephone Fax 3 ) Name Address Telephone Fax 4 ) Name Address Telephone Fax 5 ) Name Address Telephone Fax Officer Electronic Signature(required) Title(required) Date(required) Name of Customer(required) Guarantor Name(required) Social Security #(required) Home Address(required) Telephone Number(required) Guarantor Electronic Signature(required) Date(required) Submit