CREDIT APPLICATION
1. Company Information
Full Legal Name/Business Entity Phone # Fax #
Doing Business as (DBA)
Billing Address City State Zip
Company Type:
Proprietorship Partnership Franchise Corporation Other:
No. of Employees Year Business Established Annual Sales Type of
Business
Federal Tax ID State of Incorporation DUNS NUMBER:
E-Mail Address(es): Website:
2. Owner Information
Full Name (including middle initial) Title
Home Address City State Zip Phone #
3. Bank References
Bank Name Account Number Contact
Address City State Zip Phone #
Fax# Number of years doing business with this Company
4. Trade Credit References Please include fax number
Company Name Contact
Address City State Zip Phone #
Fax# Number of years doing business with this Company
Company Name Contact
Address City State Zip Phone #
Fax# Number of years doing business with this Company
Company Name Contact
Address City State Zip Phone #
Fax# Number of years doing business with this Company
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GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE
1. Net 30 days.
2. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit
dept.
3. PERSONAL GUARANTEE: If the credit customer is a corporation, LLP or LLC, then those signing this application,
whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the entity.
We are requesting credit in the amount of $
For credit approval, please scan and email to:
accounting@[Link]
Attn: Credit Department
THE ABOVE INFORMATION is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize the
company to whom this application is made to investigate the references pertaining to my/our credit and financial
responsibility. You agree to accept electronic signatures and/or fax copies of this document as creating a legally binding
document.
I have read the terms and conditions stated below and agree to all of these terms and conditions.
Authorized Signature: _____________________________________________ Date:______________
Printed name ___________________________________________________ Title:______________
