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    TAMPA TANK LINES      
    CREDIT APPLICATION        
               
NAME OF APPLICANT:                
               
FED TAX ID #:                
               
MAILING ADDRESS:                
               
CITY:________________________________________ STATE:   ZIP:      
               
               
CURRENT OWNER SINCE:     YEARS WITH THIS NAME:____________________  
               
BUSINESS DESCRIPTION:     SALES CONTACT PERSON:      
               
STREET ADDRESS:                
               
CITY:_____________________________________ STATE:   ZIP:      
               
TELEPHONE NUMBER:___________________________ FAX NUMBER:_______________________________  
               
PREMISES: OWN   RENT   LEASE      
               
IF LEASED, FROM WHOM:                
               
STREET ADDRESS:                
               
CITY:_____________________________________ STATE:   ZIP:      
               
               
FIXTURES & EQUIPMENT: OWN   RENT   LEASE      
               
IF LEASED, FROM WHOM:                
               
STREET ADDRESS:                
               
CITY:_____________________________________ STATE:   ZIP:      
               
               
PRINCIPAL OWNERS, PARTNERS, OR STOCKHOLDERS    
               
FULL NAME OF PRINCIPAL:                
               
TITLE:_______________________________________ % OF OWNERSHIP:        
               
FLORIDA DRIVERS LICENSE #                
               
SS#     HOME PHONE:        
               
HOME ADDRESS:                
               
CITY:_____________________________________ STATE:   ZIP:      
               
               
FULL NAME OF PRINCIPAL:                
               
TITLE:_______________________________________ % OF OWNERSHIP:        
               
FLORIDA DRIVERS LICENSE #                
               
SS#     HOME PHONE:        
               
HOME ADDRESS:                
               
CITY:_____________________________________ STATE:   ZIP:      
               
               
FULL NAME OF PRINCIPAL:                
               
TITLE:_______________________________________ % OF OWNERSHIP:        
               
FLORIDA DRIVERS LICENSE #                
               
SS#     HOME PHONE:        
               
HOME ADDRESS:                
               
CITY:_____________________________________ STATE:   ZIP:      
               
               
               
BANK-FINANCE COMPANY INFORMATION        
MAJOR BANK:                
NAME:_____________________ BRANCH:___________________        
               
CITY:_______________________________   STATE:          
               
OFFICER OF CONTACT:________________________ Phone:          
               
CHECKING ACCT. #___________________ SAVINGS ACCT#          
               
               
OTHER BANK OR FINANCIAL CO:              
NAME:_____________________ BRANCH:___________________        
               
CITY:_______________________________   STATE:          
               
OFFICER OF CONTACT:________________________ Phone:          
               
CHECKING ACCT. #___________________ SAVINGS ACCT#          
               
               
CREDIT REFERENCES              
               
BUSINESS NAME:_____________________________ CONTACT PERSON:        
               
ACCOUNT #:__________________________________            
               
GOODS/SERVICES PROVIDED:                
               
MAILING ADDRESS:                
               
CITY:________________________________________ STATE:   ZIP:      
               
               
BUSINESS NAME:_____________________________ CONTACT PERSON:        
               
ACCOUNT #:__________________________________            
               
GOODS/SERVICES PROVIDED:                
               
MAILING ADDRESS:                
               
CITY:________________________________________ STATE:   ZIP:      
               
               
BUSINESS NAME:_____________________________ CONTACT PERSON:        
               
ACCOUNT #:__________________________________            
               
GOODS/SERVICES PROVIDED:                
               
MAILING ADDRESS:                
               
CITY:________________________________________ STATE:   ZIP:      
               
TYPE OF OWNERSHIP: INDIVIDUAL:_______ CORPORATION:____ PARTNERSHIP:______  
NON-PROFIT:______ GOVERNMENT:____ FRANCHISE OF:_____________
               
               
FORM COMPLETED BY:                
               
TITLE: