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Credit Application2017-02-07T21:31:36-06:00

Confidential Credit Application

    Check One

    CorporationPartnershipSole ProprietorLLCGovernment AgencyOther

    Legal Name*

    Year Business Established*

    DBA*

    Federal ID or SS#*

    Address*

    City*

    State*

    Zip Code*

    Type of Business/Product

    Phone*

    Alternate Phone

    Fax

    Website

    Email Address

    Initial Order Amount*

    Credit Limit Desired*

    D & B Number

    Company Officers or Partners

    1.

    Name

    Title

    Phone

    2.

    Name

    Title

    Phone

    3.

    Name

    Title

    Phone

    If Branch or Subsidiary

    Name of Parent Company

    Address

    City

    State

    Zip Code

    Billing Address (if other than above)

    Billing Instructions (person or department to whom billing should be sent)

    Purchase Order Required?

    YesNo

    Person to contact for further information

    Bank Reference

    Bank Name*

    Address*

    City*

    State*

    Zip Code*

    Business Checking Account #*

    Loan Officer/Account Manager*

    Trade References

    List four (4) trade references open 2 years or more.

    1.

    Name*

    Phone*

    Fax

    2.

    Name*

    Phone*

    Fax

    3.

    Name

    Phone

    Fax

    4.

    Name

    Phone

    Fax

    Authorization/Acknowledgements

    The undersigned Authorizing Officer instructs any bank, business or consumer reporting agency to furnish any information they may have to obtain in response to credit/reference inquiries and agree that such information, along with this credit application, shall remain your property whether or not credit is extended.
    Payment terms: Net 30 days. A finance charge will be added to all past due balances. Buyer also agrees to pay all legal fees incurred in collection of past due accounts to the extent permitted by law. (Do not alter.)

     

    I accept these terms as listed above and use this box as my digital signature.

    Name

    Title

    Date

    Section below must be completed if applicant is a proprietorship, partnership, or corporation less than 3 years in business:

    The undersigned Individual Guarantor accepts the terms and conditions of this credit application and executed purchase orders, proposals, contracts between buyer and seller whether a credit or COD account is opened. The undersigned also guarantees payment of all charges and expenses incurred by the applicant.

     

    I accept these terms as listed above and use this box as my digital signature.

    Name of Guarantor

    Social Security #

    Residence Address