Consumer Credit Application | Bradigan's Incorporated

	** Required Fields
**Type of Service:
1. BUSINESS INFORMATION
**Business Name:
**Email:
**Street Address:
City, State, **ZIP:	,
**Phone:	..
**How Long in Business?
**Owner/Manager
**D & B Rated:
2. REFERENCES
Trade References:
**Name:	Address:
**Name:	Address:
**Name:	Address:
**Name:	Address:
**Bank Name:
**Bank Address:
3. OTHER
**Pending Lawsuits Against the Company:
4. CREDIT LINE REQUESTED
**Credit Line Requested: $
5. NOTICE
	By checking the box below, you authorize inquiry as to credit information. We further acknowledge that credit privileges, if granted, may be withdrawn at any time. I certify that all of the information I have provided is correct, and that I have read and understood the NOTICE statement listed above.


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