Mazon Application

To create an account with us you will need to fill out the “Application to Enter Into a Security Agreement” form below. Once you’ve submitted the information we will review it and contact you for further instruction.

Company Information

  • Mailing Address (if different from above)


Officers / Owners

    1. President / Member / Principal

  • 2. Vice President/Member

  • 3. Secretary / Member

  • 4. Treasurer / Member


Sales Information


Financial Information

  • Attorney Information

  • Third Party Interest in the Accounts Receivables or Inventory


Additional Items Needed

  • 1. Copy of DBA Certificate (assumed name certificate from court house) or
        Incorporation Certificate, Articles and Bylaws or
        LLC Certificate, Articles and Bylaws
    2. Financial Statement (income statement and balance sheet, if available)
    3. Accounts Receivable Aging (list of unpaid invoices)
    4. Master customer list with name, address, zip and phone
    5. One copy of a sample invoice with appropriate back-up documentation (purchase order, shipping, etc.)

Electronic Signature

  • The confidential information contained in this application is true and correct and I hereby authorize any credit investigation necessary by Mazon Associates, Inc.

Anti-Spam Verification