Click to download a PDF of our Credit Application.
Date: |
________________________________________________ |
Complete Name of Firm: |
________________________________________________ |
Mailing Address: |
________________________________________________ |
City/State: |
________________________________________________ |
Street Address (if different): |
________________________________________________ |
Phone: |
______________________ Fax:______________________ |
Email: |
________________________________________________ |
How many years at this location: |
___________ Is building owned or rented?_____________ |
Kind of business: |
________________________________________________ |
SIC Code: |
__________________________ Partnership: ___________ |
Individual Owner: |
________________________________________________ |
Corporation: |
________________________________________________ |
Years Established: ______ Incorporated?_____When? _______Where? ______________ |
Name(s) of Officer(s)
or Owner(s): |
________________________________________________ |
Federal Tax ID #
(or SSN of Owner if Private): |
________________________________________________ |
Website: |
________________________________________________ |
Name and Address of Bank: |
________________________________________________ |
Bank Officer: |
________________________________________________ |
Account #: |
________________________________________________ |
Authorized Buyers on this Account: ____________________________________________
Are Purchase Orders Required? Yes _______ No _______
CREDIT REFERENCES
1. Company Name: |
________________________________________________ |
Address: |
________________________________________________ |
City/State: |
________________________________________________ |
Phone: |
_____________________ Fax:______________________ |
2. Company Name: |
________________________________________________ |
Address: |
________________________________________________ |
City/State: |
________________________________________________ |
Phone: |
_____________________ Fax:______________________ |
3. Company Name: |
________________________________________________ |
Address: |
________________________________________________ |
City/State: |
________________________________________________ |
Phone: |
_____________________ Fax:______________________ |
The undersigned official, to induce the granting of credit to the above firm, hereby personally guarantees the Company’s credit.
Signature & Title of Corporate Officer: _________________________________________