HomeMy WebLinkAbout96-02090
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PLEASE READ CAREFUllY AND COMPLETE THE FOllOWING:
.BUSINESS INFORMATION -//7--
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Business Name: ~ - ((m.=>!Tvc-h....,-f-"TT"'" Business Phone: ::::z ~ )- CJ,3J(, 3
Street Address: 9 #7//~/.7 C:;,.",;"
City, Statal Zip: C~J/.:,/.. A1 /7~/3
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Legal ComPosition: () Corporation ~partn.rship () Individual
PRINCIPAL INFORMATION
Names, Residence Addresses, and Residence Phone Number of Individual Principals:
NAME STREET ADDRESS
a leJ1v1 f3f1/Jt+ .:::; ~ e"
A..b(JJ'tI' l3&tf
CITY, STATE I ZIP
PHONE
TYPE OF BUSINESS
, I ..nclllr ,L-f' -....1 Contrarto. ( ) In.t.ll../AppHcat<>. () _l...l. _l.. (I a.tan IlNl..
Year Established: 1913
If Incorporated, in what State:
List any other employment of business applicant is engaged in:
If Incorporated, Federal Identification number:
If proprietorship or partnerShip, please list soc1l!l11l8curity nlMllbers: .R('~-5"~.55"-</
i)d - c;:>og - 38' -..:< 72 '3
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Does applicant pay sales tax? (......r yes () no (copy of certificate IIUSt be attached)
BANK REFERENCES: Checking loans
Bank Name: HnJ1t:'f":> ':;;~~ f {" I, /, i<
Street Address: I WE sf-- f-hr.,H
City, Stete , Zip:. c.wr II~ Ie... 176 /3
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(APPLICATION CONTINUES ON BACK
ACcount Number
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