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MASONS SUPPLY COMPANY
Oregon (800) 537-3407 ♦ Washington (800) 537-6216
Clackamas | Eugene | West Eugene | Hillsboro | Medford | Portland | Salem | Wilsonville | Ridgefield | Seattle | Tacoma | Woodinville
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Soc. Sec. No. – –
Business Name
Business Street Address
City
State
Zip
Billing Address
Business Phone
Fax Number
Nature of Business
Sole Proprietor
Corporation
Partnership
LLC
Name
Address
Phone
Name
Address
Phone
How Long in Business
How Long at Present Business Address
If Less Than 1 Year Previous Address
Construction Contractors Board License No.
Dept. of Labor & Industries Contractors License No.
Expiration Date
Expiration Date
Sales Tax Resale No.
Bond Co. & Address
Phone
Bond No.
Business Bank & Branch
Phone
Name of Bank Representative to Contact
Checking No.
No
Bank Line of Credit?
Construction Lender
Phone
Contact Person
Phone
Personal Bank and Branch
Checking Account No.
Savings Account No.
Loan Account No.
Under what Name?
Business
Personal
Financial Statement Attached
Name
Name
Name
Name
Address
Address
Address
Address
Phone
Phone
Phone
Phone
If sole proprietor or partner, please list the following:
Driver’s License No.
State
Do you own your own home?
Yes
No
Address
City
State
Zip
Yes
REFERENCES (TRADE SUPPLIERS)
503-722-1528
Clackamas
541-744-6696
Eugene
541-683-1408
West Eugene
503-533-0107
Hillsboro
541-772-6161
Medford
503-234-4321
Portland
503-585-5504
Salem
503-582-9320
Wilsonville
206-767-4645
Seattle
253-581-6161
Tacoma
425-487-6161
Woodinville
360-887-4777
M A S C O . N E T
MASONS SUPPLY COMPANY
Construction and Industrial Materials
Attn: Bookkeeping Office – P.O. Box 42367
CREDIT APPLICATION