K N Wattenberg Transmission LLC

Original Volume No. 1

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Effective Date: 04/01/1993, Docket: CP92-203-002, Status: Effective

Original Sheet No. 71 Original Sheet No. 71 : Effective

 

TRANSPORTATION SERVICES

CREDIT APPLICATION

 

þ K N WATTENBERG TRANSMISSION LIMITED LIABILITY COMPANY

 

P.O. Box 281304

Lakewood, Colorado 80228-8034

 

Customer Name and Address ____________________________________________________________________

_______________________________________________________________________________________________

Type of business: þ Corporation þ Partnership þ Individual

þ Other þ Specify_____________________________________________

State incorporated in________________________ Tax ID Number _____________________________________

Number of years in business under current name________________________________________________________

Has the customer changed its name in the last 5 years? þ Yes þ No

If yes, furnish prior name & address: _______________________________________________________________

______________________________________________________________________________________________________

 

List the three principal owners, stockholders, partners, or officers of the customer

Name _____________________ Name _____________________ Name __________________

Title _____________________ Title _____________________ Title __________________

Address _____________________ Address _____________________ Address __________________

_____________________ _____________________ __________________

Phone _____________________ Phone _____________________ Phone __________________

 

If a wholly owned subsidiary, name and address of parent _____________________________________________

______________________________________________________________________________________________________

Is Parent company responsible for subs debts? þ Yes þ No If yes, please furnish documentation.

Billing Address _____________________________________________________________________________________

Contact Person_________________________________________________ Phone _______________________

Amount of Credit Requested $_________________________ Net Worth $__________________________

 

Please Furnish One Bank Reference

 

Name ____________________________ Phone ___________________________________

Address ____________________________ Account Types ___________________________________

____________________________ Account Nos. ___________________________________

Contact ____________________________ ___________________________________

 

Please Furnish Two Business Credit References

 

Name _____________________________ Name ___________________________________

Address _____________________________ Address ___________________________________

_____________________________ ___________________________________

Contact _____________________________ Contact ___________________________________

Phone _____________________________ Phone ___________________________________