Burmax Credit Application

To proceed with the application, please select your business category:

*No salons please.

Business Contact Information
Person Name*
Company Name*
Phone*	Fax	E-mail*
Address*	Address 2
City*	State*	Zip*
Date Business Commenced
Type of Business	If Other
Title or Position	If Other

Business and Credit Information
Contact Name
Address	Address 2	How long at current address?
City	State	Zip
Phone	Fax	E-mail
Bank Name*	Bank Phone
Bank Address	Bank Address 2
Bank City	Bank State	Bank Zip
Type of Account	If Other	Account Number

Business/Trade References
1st Company Name*	Address*	Address 2
City/State/Zip*	Phone*	Fax
E-mail*	Type of Account
2nd Company Name	Address	Address 2
City/State/Zip	Phone	Fax
E-mail	Type of Account
3rd Company Name	Address	Address 2
City/State/Zip	Phone	Fax
E-mail	Type of Account

Terms
Burmax standard credit terms are Net 30 Days. Customer authorizes Burmax to contact the above references and agrees to comply with Burmax terms and conditions. Freight chargers may be deducted from your invoice on orders of $1595.00 or more shipped to any destination within the continental United States and when paid within 10 days from receipt of merchandise. Freight cannot be deducted on any furniture or drop shipments.
Signature
By typing my name below, I agree to the terms stated above.