Credit Application
Customer Name :
C-Corporation
S-Corporation
Partnership


Trade Name :
Address :
City :
State:    
Zip :    
 
Business Description :
Resale # :
Amount of Credit Requested : $
     
Are C.O.D terms accetable while in credit investigation : Yes No      
 
Contact Information :
Contact Person :   Account Payable
 
Bank References:
Name :
Name :
Address :
Address :
City/State/Zip :
City/State/Zip :
Phone :
Phone :
Fax :
Fax :
Account No :
Account No :
 
Trade References:
Name :
Name :
Address :
Address :
City/State/Zip :
City/State/Zip :
Phone :
Phone :
Fax :
Fax :
 
Name :
Name :
Address :
Address :
City/State/Zip :
City/State/Zip :
Phone :
Phone :
Fax :
Fax :
 
The above is for the purpose of obtaining credit and is warranted to be true. I / We herby authorize the firm to whom this application is made to investigate the references listed pertaining to my / our credit and financial responsibility. A copy of this document shall be as the original. I herby acknowledge that the above information is true to the best of my knowledge.
 
   
Electronic signature (type your name) Title Date
 

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