Credit Application

Fill in your information

 
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: _________________________________________

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