Application for Credit


Please print this page with your internet browser and mail completed application below to:
Ritchey's Dairy, Inc.
2130 Cross Cove Road
Martinsburg, PA 16662

Last Name
First Name
Middle Initial
Social Security Number
Phone Number
Present Address
Work Phone
Place of Employment
Products you want
to purchase each week

I give the Credit Bureau, Inc. permission to pull my credit profile and release the information on file to Ritchey's Dairy, Inc.
Signature X                                                                                                                             Date


Visitors to page since May 30, 2005