Application form for credit granting

Name of the Borrower:
In the name of:
Acting on the basis of:
Credit sum:
Term:
Interest Rate:
Credit purposes:
Source of repayment:
Credit security:

In case of В случае non-performance of obligations on the Credit Agreement we entrust the Bank to indisputably debit the payable sum from our transaction account or other accounts of ours:
Bank requisites (transaction account):
Juridical address:
Telephone: Fax:
Contact persons:
Contact phone numbers:
Director:
Accountant-general: