Logo Blind Industries and Services of Maryland
3345 Washington Blvd · Baltimore, Maryland 21227
(410) 737-2600 phone / (410) 737-2665 fax
ACCOUNT APPLICATION

Bill to:

Ship To: (if different)

Address

Address

City, State, Zip Code

City, State, Zip Code

Phone Number

Subsidiary or Division of

Business Type:

________Partnership   
________Proprietorship   
________Corporation
In Business

________ Years

Present Management

________ Years

PRINCIPALS IN BUSINESS

Name

Title

Address

Phone
       
       
       

COMPANY BANKS WITH

Name

Location

Contact

Phone
       

OPEN ACCOUNT SUPPLIERS

Name

Address

Contact

Phone
       
       
       

Type of Business
Listed with Dun & Bradstreet     Yes   No

Comments
 
 

Tax-Exempt?      _____Yes _____No
If Tax-Exempt, please supply copy of Card or Certificate.

Customer Signature

 

Title

Date

Sales Representative

 

Rep Group

Date

BISM-1005