IP&E Holdings, LLC (dba IP&E Guam)
Ste. 100 643 Chalan San Antonio
Tamuning, Guam 96913-3644
Tel: (671) 647-0000 Fax: (671) 649-4353

Applicant Information

Name:

Trade Name (if any):

Type of Business:

Years of Operation:

No. of Employees:

Business Location Address:

Business Mailing Address:

Telephone Number:

Fax Number:

Email Address:

Partnership

Corporation

Sole Proprietor

Principal Officers

Name

Position

	RECENT FINANCIAL STATEMENTS ARE REQUIRED WHERE MONTHLY PURCHASES ARE TO EXCEED $5,000. ALSO, PLEASE SUBMIT A CURRENT BUSINESS LICENSE WITH APPLICATION.
	Bank Reference(s)

Bank Reference(s)

Name of Bank

Type of Account

Account Number

Checking
Savings

Authorization to Release Information

The undersigned authorized the above credit references to disclose financial information as requested by IP&E Guam, in connection with his application for credit with IP&E Guam and its applicable companies. A copy or facsimile of this form shall be deemed acceptable to you as proof of my (our) authorization.

Applicant:

Date:

Company

Title

Printed Name

Signature

Are company officers prepared to sign personal guarantees if deemed necessary?

Yes

Under penalties of perjury, the undersigned declares that the statements herein are true and correct to the best of my/our knowledge.

Authorized Representative(s) Print Name and Title

Signature

Date