CREDIT APPLICATION |
FAX: 646-519-4723 |
COMPANY INFORMATION |
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NAME: |
REFERRED BY: |
ADDRESS: |
DATE BUSINESS STARTED: |
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ESTIMATED ANNUAL SALES: |
CITY/STATE/ZIP: |
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PHONE: |
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ACCOUNT # |
FEDERAL ID# |
NAMES OF OWNERS, PARTNERS, PRESIDENT & ACCT. PAYABLE CONTACT |
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TRADE REFERENCES |
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FAX |
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BANK INFORMATION |
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BANK: |
BANK: |
ADDRESS: |
ADDRESS: |
CITY/STATE/ZIP: |
CITY/STATE/ZIP: |
PHONE: |
PHONE: |
ACCT# |
ACCT# |
APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES
IN
ACCORDANCE WITH OUR CREDIT TERMS:
The above information is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize the firm to whom this application is made to investigate the references listed pertaining to my/our credit and financial responsibility. |
BY: _____________________________________
TITLE: ___________________________________
DATE: ___________________________________