Otis Bed Manufacturing

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Business Info:		Shipping Info:
Name:		Name:
Address:		Address:
City:		City:
State:		State:
Zip:		Zip:

Phone:		Email:
Fax:		Web Address:

Business Details
Type of Business:		Date Established:
Principal Owner or Officer:		Title:
Social Security:		Federal ID#:

Bank Reference
Name:		Branch:
Phone#:		Account #:
Contact:

Trade References
Name:		Phone #:
Address:		*FAX:

Name:		Phone #:
Address:		*FAX:

Name:		Phone #:
Address:		*FAX:
*We prefer to contact your trade references by FAX

Bank Authorization
I authorize Otis Bed Manufacturing to receive bank information for the purpose of obtaining a commercial line of credit and to warrant that the above information submitted is true and accurate.
Name:		Title:

Personal Guarantee
In the event the account becomes delinquent, I understand that I am personally liable for the company charges and am also responsible for resonable charges and/or attorney's fees.
Name:		Title:

Click to download a printable copy of the Otis Bed Resale Certificate.
This must be filled out and mailed or faxed to Otis Bed.