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263 Old Country Road | Melville, NY 11747 | 800.545.6776 OPT #2 | FAX 631.367.0513 Security and Guarantee
Section B: Contact Information Buyer Name:
Address: Telephone:
Cell Number: Accounts Payable Contact:
Address: Telephone:
Cell Number:
Section C: Company Banking Information Bank Name:
Name Bank Account: (If different from above)
Address: City:
Bank Officer / Contact Name: Telephone:
Section C1: Guarantor Banking Information Bank Name:
Name Bank Account: (If different from above)
Address: City:
Bank Officer / Contact Name: Telephone:
Province: Title: Years with Bank: Province: Title: Years with Bank: Title: Fax: E-mail: E-mail: Fax:
Business Account #: Loan Account #:
Postal Code:
Business Account #: Loan Account #:
Postal Code:
3
US FL - 7/7-REV:11-2010 (Rev. 9/6/13) US FL - 3/7-REV:11-2010 FOR ORDERS, CALL 800.233.6261 FOR SYSTEM SALES AND SUPPORT, CALL 800.234.7971 WWW.ADIGLOBAL.COM/US 855