Customs Brokers & Int L Freight Forwarders s1

JOHN F. KILROY CO., INC. Customs Brokers & Int’l Freight Forwarders One Cross Island Plaza, Suite 203E ~ Rosedale, NY 11422 ~ U.S.A. Tel: 718-656-7818 ~ FMC 000114NF ~ Fax: 718-656-8888 Email: [email protected] Web Site: www.jfkilroy.com

Credit Application

Company ______

Address ______Federal ID#______

City ______State ______Zip ______

Tel ______Email ______

Name(s) of Officers / Partners / Principals (Include Title)

1. ______2. ______

3. ______4. ______

Corporation ______Partnership ______Sole Proprietor ______Year Established ______

Estimated Annual Sales ______Controller ______

Credit Reference

Bank ______Account No. ______

Address ______State ______Zip ______

Tel ______Account Officer ______

Trade References

Company ______Address ______

Tel ______Email ______Contact______

The above information is required in order to establish an open account with your firm, with the understanding, all charges will be paid upon receipt of our invoice. Any information contained herein will be considered confidential by JOHN F. KILROY CO., INC. Date ______Signature ______Title______

Dependable Service Since 1932