Fill and Sign the Credit Form PDF

BUSINESS CREDIT APPLICATION Business Name: _____________________________________ Date: ____________________ Address: _____________________________ Credit Line Requested $____________________ City/State/Zip_________________________________________ Resale No._______________ Owner/Manager: _______________________________ Tel. No.: ____________________ How long in business: _______________ D & B Rated:________ [ ] Sole Proprietor [ ] Partnership Trade References: Name Address Contact Phone ____________________ ____________________ __________________ ____________________ ____________________ __________________ ____________________ ____________________ __________________ Bank References: Name of Bank Address Contact Account # ____________________ _________________ __________________ ____________________ _________________ __________________ ____________________ _________________ __________________ Persons authorized to issue Purchase Orders: _________________________________________ The undersigned authorizes inquiry as to credit information. We further acknowledge that credit privileges, if granted, may be withdrawn at any time. The undersigned agrees to pay all invoices on time, pay ____% per month service charge on past due amounts, and pay legal and attorney fees if collection of account is necessary. _________________________________________________ - 1 - ___________________________________ Authorization Title - 2 -