Business Credit Application Form

Company name
DBA (if different)
Contact person
Address
Phone		Fax
Federal tax ID or Social Security number.
Type of business		No. of employees
Date business established
Types of products you will purchase
Amount of credit requested $
Are you a:
CORPORATION
State of incorporation
Names, titles, and addresses of your three chief corporate officers
Name and address of your resident agent
PARTNERSHIP
Names and addresses of the partners
SOLE PROPRIETORSHIP
Are you sales tax exempt?	Yes		No
Have you ever had credit with us before?	Yes		No
If yes, under what name?
Authorized purchasers
Purchase order required?	Yes		No

TRADE REFERENCES
Reference #1	Name:
	Address:
	Phone:
Reference #2	Name:
	Address:
	Phone:
Reference #3	Name:
	Address:
	Phone:
BANK REFERENCES
Bank#1	Account #:
	Phone:
	Contact person:
	Name of bank:
	Address:
Bank#2	Account #:
	Phone:
	Contact person:
	Name of bank:
	Address:
I represent that the above information is true and is given to induceÂ to extend credit to the applicant. My company and I authorizeÂ to make such credit investigation asÂ sees fit, including contacting the above trade references and banks and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself.
I have read the terms and conditions stated below and agree to all of these terms and conditions.
Authorized signature:
Printed name:
Title:	Date:
GENERAL TERMS AND CONDITIONS AND PERSONAL GUARANTEE
Bills are sent on the first day of each month. You may take the 5% discount as indicated on the bill if you pay the invoice by the 10th of the month. All bills become payable in full on the 11th day of the month and if not paid by the end of the month are considered past due. A service charge of 2% per month will be added to all amounts billed if not paid by the end of the month. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. PERSONAL GUARANTEE: If the credit customer is a corporation, then those signing this application, whether signing as an officer or not, personally guarantee payment for all items purchased on credit by the corporation.