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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.


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