Credit Application
Credit Application
Credit Application
Applicant Information:
Legal Name: ___________________________________________________________________
D/B/A (if different): _____________________________________________________________
Telephone: ________________________________
Fax: ______________________________
Website: ______________________________________________________________________
Mailing Address: _______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Shipping Address: ______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Other Persons Authorized To Enter Into Legal Contracts for the above named business (other
than person completing this application):
_____________________________________________________________________________
_
Authorized Purchasing Agent(s)/ Buyer(s): ___________________________________________
_____________________________________________________________________________
_
Type of Business:
Corporation
Partnership
Proprietorship
_____________________________________________________________________________
_
_____________________________________________________________________________
_
_____________________________________________________________________________
_
Has this Business ever been bankrupt?
Yes
Checking
Savings
Checking
Savings
Trade References:
Business Name:_________________________________________________________________
Business Address: ______________________________________________________________
Telephone: _______________________________ Fax: ________________________________
Contact Person: _______________________________ Account Number: _________________
Business Name:_________________________________________________________________
Business Address: ______________________________________________________________
Telephone: _______________________________ Fax: ________________________________
Contact Person: _______________________________ Account Number: _________________
Business Name:_________________________________________________________________
Business Address: ______________________________________________________________
Date: ________________________