Providing quality customer service since 1949
CorporationPartnershipSole ProprietorLLCGovernment AgencyOther
Year Business Established*
Federal ID or SS#*
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Type of Business/Product
Initial Order Amount*
Credit Limit Desired*
D & B Number
Name of Parent Company
Billing Address (if other than above)
Billing Instructions (person or department to whom billing should be sent)
Purchase Order Required?
Person to contact for further information
Business Checking Account #*
Loan Officer/Account Manager*
List four (4) trade references open 2 years or more.
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.
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.
Name of Guarantor
Social Security #