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El
Paso Corporation & Subsidiaries
Attention: Credit Department 1001 Louisiana Return to: Sharon Kimball Phone: (713) 420-2062 Fax: (713) 420-1924 Ted Chavez Phone: (713) 420-3068 Fax: (713) 420-1924 Gary Hammett Phone: (713) 420-4360 Fax: (713) 420-1924 Date: CREDIT INFORMATION Instructions: Complete the following information, attach your most recent copies of the following items (as applicable), and return to the above address as soon as possible:
Company Information Name: Attention: Address:
Accounts Payable Contact, Title, & Phone:
Marketing Contact, Title, & Phone:
Classification ( check
one)
Private-Corporation Public-Corporation
S-Corporation
Governmental General-Partnership Limited-Partnership
Sole
Proprietor Nonprofit
Fiscal Year End:
D&B No: Description of Business
Activity:
Officers and Controlling Shareholders (Complete only if a Nonpublic Company)
Name
Title
Ownership
Parent Company Name: Address:
D&B No: If necessary, will parent guarantee payment? Yes No
CREDIT INFORMATION (Continued) Trade References Company/Address Phone/Contact
Person 1. Company: Phone: Address: Fax No: City, State, Zip: Contact Person: 2. Company: Phone: Address: Fax No: City, State, Zip: Contact Person: 3. Company: Phone: Address: Fax No: City, State, Zip: Contact Person: 4. Company: Phone: Address: Fax No: City, State, Zip: Contact Person: Bank References Name: Address:
Contact: Phone:
Fax: 1. We hereby authorize El Paso Corporation and/or its
subsidiaries to obtain or exchange any information that may be required
relative to this Application from any source, including Applicant's financial
institutions, trade suppliers, and credit information databases. Applicant
authorizes each source to provide such information. 2. The undersigned Applicant certifies that
the information supplied on this Credit Application ("Application")
is accurate and correct as of the date of this Application.
By:
Applicant's Signature
Name:
Title:
Date: |