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Online Application for Credit - Commercial
Email address of applicant
Business Name Telephone
Mailing Address
City State Zip Code
Contact Telephone Number Contact Person
Shipping Address
D/B/A (Doing Business As) Federal ID Tax Number
Former Business Address
Type Of Business Date Established Years In Business
Trade Reference 1 Current Monthly Credit Limit
Mailing Address
City State Zip Code
Contact Telephone Number Contact Person
Trade Reference 2 Current Monthly Credit Limit
Mailing Address
City State Zip Code
Contact Telephone Number Contact Person
Trade Reference 3 Current Monthly Credit Limit
Mailing Address
City State Zip Code
Contact Telephone Number Contact Person
Ownership
Principal Name Title Social Security #
Principal Name Title Social Security #
Principal Name Title Social Security #

BANK REFERENCES
Bank Name & Account Number Person To Contact & Telephone Number
Bank Name & Account Number Person To Contact & Telephone Number
Bank Name & Account Number Person To Contact & Telephone Number

 
No. of Employees   Est. Annual Sales $  Sales Area 
Has the firm or any of its Principals ever been bankrupt? Yes   No
If yes, please explain:
The submitter as an inducement to grant credit to me or to my agent(s) agrees to the following terms:
Our terms are Net 30 days from invoice date.
An invoice is provided to you at pick-up or delivery, no statement will follow.
Service charge compounded on overdue accounts at the rate of 1.5% per month.
   I Accept The Terms Above

PERSONAL GUARANTEE
I / We individually and where applicable, acknowledge acceptance of the above mentioned credit arrangement and guarantee the prompt payment of all sums personally, now or hereafter due from the above named individuals or business entity.

I / We understand that the addition of a corporate title to signature does not alter the individual nature of the guarantee.

   I Accept The Terms Above

 

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