Credit Application

Company Information
Full Legal Name Doing Business As (DBA)
Phone Fax
Billing Information
Billing address City
State Zip
Type of business
Proprietorship Partnership
Corporation Other
State of incorporation
Year business established Annual Sales
Number of employees Federal Tax Id (if incorporated)
Email Address Website
Bank reference
Bank Name Contact
Address City
State Zip
Phone Fax
Account #
Trade Credit References (2)
1 - company name 2 - company name
Address Address
City City
State State
Zip Zip
Phone Phone
Fax Fax
Main contact Main contact
We hereby apply for credit and affirm financial responsibility and willingness to pay invoices in accordance with published terms. The above information is warranted to be true and complete. We hereby authorize you to verify and collect information on us, including but not limited to, bank references, trade credit references, consumer and/or commercial credit reports. We agree to pay a monthly finance charge of the maximum applicable rate on all past due balances. We agree to pay all costs of collection and litigation on this account in accordance with the laws of the Creditor's State of Incorporation. We agree that all decisions with respect to the extension or continuation of credit shall be in the sole discretion of the Creditor.