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User Name
Password
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.
