Powerhouse Two Batteries

Commercial Client Application

First Name
Last Name
Company Name
Date
Address
Address
City
State	Zip
Phone
Fax
E-Mail
Website
Check one	Corporation Partnership Proprietorship
Type of Business
Resale / Sales Tax ID
FEIN
Purchasing Agent Name
Phone
Fax
E-Mail
Accounts Payable Name
Phone
Fax
E-Mail
Multiple Locations?	If yes, how many?

Please list three companies you do business with.

Company
Address
Address
City
State
Zip
Phone
Fax
Doing Business Since

Company
Address
Address
City
State
Zip
Phone
Fax
Doing Business Since

Company
Address
Address
City
State
Zip
Phone
Fax
Doing Business Since

Bank Information
(If applying for open terms)

Name
Account No
Contact
Phone
Fax

Your Legal Name

SID: 8694
Enter SID number in the box below as your digital signature

I certify that all statements made by me in this application are correct to my knowledge. I authorize the above named bank to release information regarding my account as requested by Powerhouse Two.