Business Credit Application

    Name/Address

    Last:

    First:

    Middle Initial:

    Title

    Name of Business:

    Tax I.D Number

    Address:

    City:

    State:

    ZIP:

    Phone:

    Company Information

    Type of Business:

    In Business Since:

    Legal Form Under Which Business Operates:

    If Divison/Subsidiary, Name of Parent Company:

    In Business Since:

    Name of Company Principal Responsible for Business Transactions:

    Title:

    Address:

    City:

    State:

    ZIP:

    Phone:

    Name of Person Responsible for Accounts Payble:

    Title:

    Address:

    City:

    State:

    ZIP:

    Phone:

    Bank References

    Institution Name:

    Checking Account#:

    Address:

    Email:

    Phone:

    Trade References

    Company Name:

    Company Name:

    Company Name:

    Contact Name:

    Contact Name:

    Contact Name:

    Address:

    Address:

    Address:

    Phone:

    Phone:

    Phone:

    Account Opened Since:

    Account Opened Since:

    Account Opened Since:

    Credit Limit:

    Credit Limit:

    Credit Limit:

    Current Balance:

    Current Balance:

    Current Balance:

    Signature

    I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institution listed in this credit application to release necessary information to the company for witch credit is being applied for in order to verify the information contained herein.

    Name:

    Phone No:

    E-mail: