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

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

Prove you're not a robot.