South Coast Beacon -- News and Events in Santa Barbara, Goleta, Carpinteria, Montecito

	Local information here in the South Coast.

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Credit Application

Prior to the return and approval of this
completed form, advertising must be prepaid.

Please Enter Your Contact Information:

Date:		Amount of credit requested:
Business/Corporate Name		DBA:
Address:		Mailing Address:
Phone:		Fax:
A/P Contact:		Contact Email:
Parent Company Name:		Parent Company Address:
Company Profile:		Dunn & Bradstreet #:

Officers or Principals:

Name and Title	Residence		SS#



			Please note: Our server is NOT secure. Due to privacy concerns, we will contact you for your Social Security number, if you do not wish to input it.
Advertising:

Have you advertised with us before?:		Under what name?:
Account Number:		Date:

Credit References (preferably media):

Name	Address and Phone number		Account Number



			Please note: Our server is NOT secure. Due to privacy concerns, we will contact you for your Account number if you do not wish to input it.
Bank References: (Indicate: C-Checking or S-Savings):

Name and Kind	Address and Phone number		Account Number



			Please note: Our server is NOT secure. Due to privacy concerns, we will contact you for your Account number if you do not wish to input it.

Local information here in the South Coast.