CREDIT APPLICATION
Full Company Name _____________________________________________
Address ______________________________________________________
City _______________________________ State _____________________ Zip _________________
Contact Name _______________________ Phone ____________________ Fax ________________
How long at above address? ____________ Property owned by _______________________________
Type of Business: Corporation Partnership Sole Proprietorship
Tax EIN # _________________________ Date Business Started _____________________________
Type of Purchase: End User For Resale *Attach resale certificate Other ________________
CORPORATE OFFICERS
_________________________________ Title: __________________________
_________________________________ Title: __________________________
_________________________________ Title: __________________________
PARTNERS OR OWNERS
________________________________________________________________
________________________________________________________________
________________________________________________________________
Estimated Credit Requirements $ ______________________________________
Financial References:
Your Bank _____________________________________ Branch: _______________________
Type of account _________________________________ Account #: ____________________
Bank Phone #: __________________________________ Bank Fax #: ____________________
Bank Contact Name _____________________________
Your Bank _____________________________________ Branch: _______________________
Type of account _________________________________ Account #: ____________________
Bank Phone #: __________________________________ Bank Fax #: ____________________
Bank Contact Name _____________________________
Trade References:
|
Vendor Name
|
City, State
|
Account #
|
Fax #
|
| _______________________ | _________________ | _________________ | __________ |
| _______________________ | _________________ | _________________ | __________ |
| _______________________ | _________________ | _________________ | __________ |
We certify that the information on this form is correct. We understand your
terms are
Net 30 (with late fee of 1 1/2% per month), and agree to the proper payment
in
consideration of extended credit. Further, we authorize you to contact the references
given above and for them to release any information you feel pertinent.
Financial Officer's Signature _______________________ Title ___________________
Date ___________
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