Credit Application Business Name Date Business Started Billing Address Shipping Address Do you require third-party billing? YesNo Accounts Payable Phone Number Accounts Payable Email D-U-N-S # Names of Officers, Partners, Owners Name Title Do you need to enter an additional officer, partner or owner? YesNo Name Title Do you need to enter an additional officer, partner or owner? YesNo Name Title Type of Business Industrial Own UseOEMN/A Distributor StockingNon-StockingN/A Business Structure CorporationSole Proprietor Principal Product Manufactured Bank Information Business Bank Business Full Address Checking Account Number Bank Phone Number Bank Fax Number Trade References Trade Reference 1 Name Address City State Zip Code Phone Number Fax Number Email Trade Reference 2 Name Address City State Zip Code Phone Number Fax Number Email Trade Reference 3 Name Address City State Zip Code Phone Number Fax Number Email Signature Requirement IN MAKING THIS APPLICATION FOR CREDIT, THE CUSTOMER AGREES TO PAY ALL INVOICES WITHIN 30 DAYS FROM THE INVOICE DATE AND TO PAY A SERVICE CHARGE OF 1½% PER MONTH (EQUATES TO 18% ANNUALLY) ON ALL OVERDUE BALANCES. IN THE EVENT A SUIT IS NECESSARY TO COLLECT ANY AMOUNT, THE CUSTOMER AGREES TO PAY THE SELLER’S REASONABLE ATTORNEY FEES AND COSTS INCLUDING ATTORNEY FEES FOR APPEAL. SIGNING BELOW INDICATES THAT YOU UNDERSTAND THE TERMS OUTLINED AND CONSENT TO FOLLOW THEM ACCORDINGLY. Signature of Officer (Full Name) Title Date Drag and drop files here or Browse Files Upload upto 5 Files. Max File Size: 20 MB
