Application for Credit
Company Information
Name of firm
State Resale Tax ID No.
Email Address
Company Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Number of years in business
Phone Number
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Fax Number
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Ship to Address (if different from above)
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Business Type
Proprietorship
Partnership
Corporation
Check here if cash sales are OK until credit is approved
Owner Information
Owner Name
Social Security No.
Home Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Bank References
Bank Name
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Name of Bank Officer to contact
Bank Phone Number
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Trade References
Business Reference #1
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone Number
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Business Reference #2
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone Number
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Agreement:
In making this application for credit, I/we herby agree that all amounts are payable on or before the “net due” date as shown on each invoice, and if not paid on or before said date are delinquent. I/we will be placed on a C.O.D. basis until such time that my/our account is brought current.
If credit is granted, I/we agree to the terms and the undersigned is/are responsible for payment of the account. In consideration of your extending credit to the above firm at my/our request, I/we hereby personally guarantee the payment of all their obligations to you until withdrawn by me/us by certified mail. I/we waive notice of acceptance of the guaranty, notice of the sale of goods, wares and merchandise sold by you to the customer designated above, and notice of default. I/we consent to the extension of time of payment of the indebtedness or any portion thereof. I/we do further agree that if this matter is placed into in the hands of an attorney for collection, or if collection is made through pro-bate proceedings, to pay a reasonable amount in attorney’s fees on both the principal and the delinquency charges.
Name
Date of Application
