Nejad Rugs - Dealer Application Form

Credit Application and Purchase Agreement
For valuable consideration recieved and in order to induce Nejad Oriental Rugs, Inc. to extend credit to:
 Legal Company Name (hereinafter referred to as Company):
           
 Legal Company Address:
 Street: 
City  State  Zip  Tel
Fax:  * E-Mail: 
Legal Company Status:
Inc.     Partnership     Ownership      Other 
If Other, please explain: 
Bank Name:
    Account#: 
City  State  Zip  Tel
Are you listed with Dunn & Bradstreet?:      If yes, Rating: 
Trade References:
Provide 3 references with which you have conducted business in the past 2 years:
(1): Address: 
City  State  Zip  Tel
(2): Address: 
City  State  Zip  Tel
(3): Address: 
City  State  Zip  Tel
Principals of the Company:
(1):  Pos:  Tel:
(2):  Pos:  Tel:
Undersigned for:
  Title:   Date:
Business Name:
Phone: 
Special Requirements or Considerations (This field is Optional):

Please submit form only once!

Please contact us with questions regarding the Dealer Application, or any other assistance you need.
Corporate Office:   NEJAD  •  Main & State Streets  •  Doylestown, PA 18901  •  TEL: 800.245.7847  •  FAX: 215-348-9056