Thompson Brothers

Welding & Industrial Supply, Inc

2319 W. 8th, Coffeyville, KS 67337
PH(620)251-1740 Fax(620)252-6390

3700 E Tuxedo, Bartlesville, OK 74006
Ph(918)333-5656 Fax(918)333-5657

Cylinder / Credit Application
Date:___________________

Approved By:_______________________
Location:___________________________

Name or Firm:____________________________________________________________________
Social Security Number:___________________ Telephone Number:________________________
Address: _____________________________ City:______________________State:____Zip:____
If Address is a PO Box and/or Rural Route, please give directions:_________________________
________________________________________________________________________________
________________________________________________________________________________
Name, Address & Phone Number of friend or relative reference:___________________________
________________________________________________________________________________
Owner(s)/Officer(s) if business:______________________________________________________
Sales tax number:_____________________ Federal Tax ID Number:_______________________
Type of Business:_________________________________________________________________
Trade References:
Name Address Phone# Acct#
#1______________________________________________________________________________
#2______________________________________________________________________________
#3______________________________________________________________________________
Bank References:
Name Address Phone# Acct#
#1______________________________________________________________________________
#2______________________________________________________________________________
#3______________________________________________________________________________
Credit limit requested: $_______________________(not necessary for cylinder lease application)
Place of Employment:_______________________ ? Term of Employment:___________________
How long at present address:__________________________ Do you own your home: Yes or No
Have you had a cylinder lease before: Yes or No If so. Where:____________________________

Policy Regarding Cylinder Leases
All cylinder leases must be approved by application. If application is refused for any reason, a $75 Deposit PER EACH CYLINDER will be required. No sale is concluded until lease and contents are fully paid. All Cylinder Leases are NON-TRANSFERABLE. Terms are NET 30 DAYS. Delinquent accounts will be placed on C.O.D Terms. All cylinder leases 60 days past due will be picked up and leases will be canceled. Upon executing the above cylinder/credit application, I hereby authorize any business or bank reference listed to release any information concerning my account to:
Thompson Brothers Supplies, Inc. 2319 W. 8th St Coffeyville, Ks. 67337
Signature of Applicant:______________________________________