Credit Application

BUSINESS CONTACT INFORMATION

Date of Application *

Company Name: *

Phone *

Fax

Email *

Registered company address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date business commenced

Business Type *

BUSINESS AND CREDIT INFORMATION

Primary business address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Fax

Email *

Names of Authorized Representatives

President

Accounts Payable Manager

Purchasing Manager

Bank Name

Bank Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Bank Phone

BUSINESS/TRADE REFERENCES

1. Company Name

1. Contact Person

1. Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

1. Phone

1. Email

2. Company Name

2. Contact Person

2. Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

2. Phone

2. Email

3. Company Name

3. Contact Person

3. Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

3. Phone

3. Email

TERMS

I understand that your terms of sale are NET 15 DAYS and interest of 2% PER MONTH will be charged on overdue accounts.
I understand that any credit granted is at your discretion and may be varied, reduced or cancelled at any time without notice.
I authorize you to contact any and all banks, suppliers or other persons to obtain such credit information as you deem appropriate in considering granting of this credit application or in maintaining my credit status.
I agree to pay and indemnify you for all legal fees and disbursements incurred by you if legal collection procedures become necessary.
I certify that the above information is true.

Name Of Authorized Representative *

First

Last

BUSINESS CONTACT INFORMATION

BUSINESS AND CREDIT INFORMATION

Names of Authorized Representatives

BUSINESS/TRADE REFERENCES

TERMS

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