|
| 281-B Highway 72, Burnsville, MS 38833 | |
|---|---|
| Toll Free: 1-866-872-9990 / 1-866-872-9991; Fax #: (662) 427-0326 |
 |
CLIENT REQUEST FOR NEW CUSTOMER SET-UP |
 |
PLEASE PRINT, FILL-UP and FAX DIRECTLY TO LEXINGTON APPAREL INC.
Customer: _____________________________________________________________
Billing Address: _________________________________________________________
City: _________________________________ State: _________ Zip: ______________
800 #:__________________ Local #:___________________ Fax #:________________
A/P Contact: _____________________________ E-mail:________________________
CREDIT REFERENCES:
| 1. | __________________________________ | __________________________________ |
| BUSINESS NAME | ADDRESS: | |
| __________________________________ | __________________________________ | |
| PHONE # | CITY STATE ZIP | |
| 2. | __________________________________ | __________________________________ |
| BUSINESS NAME | ADDRESS: | |
| __________________________________ | __________________________________ | |
| PHONE # | CITY STATE ZIP | |
| 3. | __________________________________ | __________________________________ |
| BUSINESS NAME | ADDRESS: | |
| __________________________________ | __________________________________ | |
| PHONE # | CITY STATE ZIP |
| ____________________________________ | __________________________________ |
| CREDIT REQUESTED BY (PLEASE PRINT) |
SIGNATURE |
| _____________________ | |
| DATE |