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Credit Application Form

Business Information

Business Name *

Address *

City *

State *

Zip Code *

Phone *

Email *

City *

Mailing Address (if different)

Address

City

State

Zip Code

Additional Business Information

Parent Company Name (if applicaable) *

Type of business started *

Years at present location *

Year business started *

Tax Exempt Certificate number *

Federal ID number *

Type of Organization *

Years at present location *

Has the Company been involved in any bankruptcy or insolvency proceedings? *

Yes

Company officers

First Officer

Name *

Position *

Home Address *

City *

State *

Zip code *

Second Officer

Name *

Position *

Home Address *

City *

State *

Zip code *

BANK REFERENCES

First Bank

Bank Name *

Account Number *

Contact Person *

Phone Number *

Second Bank

Bank Name *

Account Number *

Contact Person *

Phone Number *

Trade References

First Trade Reference

Name *

Address *

City *

State *

Phone Number *

Second Trade Reference

Name *

Address *

City *

State *

Phone Number *

Third Trade Reference

Name *

Address *

City *

State *

Phone Number *

Fourth Trade Reference

Name *

Address *

City *

State *

Phone Number *

In making this application for credit, the customer agrees to pay all invoices within 30 days from date of invoice and to pay a service charge of 3 percent per month, which is an annual percentage rate of 18 percent on all overdue balances. In the event a suit is necessary to collect any amount, the customer agrees to pay the Seller's attorney's fees and costs including attorney's fees for appeal. By signing this agreement, authorization is hereby given to the vendors and banks listed herein to provide (the company) with all information necessary to establish credit with them. I hereby authorize( the company) to investigate the information presented. This account will be personally guaranteed by the persons listed below.

I agree *

Yes

Name *

Title *

DATE: 04-27-24 09:35:09

Credit Application Form

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