CREDIT APPLICATION

 

FAX: 646-519-4723

COMPANY INFORMATION

NAME:

REFERRED BY:

ADDRESS:

DATE BUSINESS STARTED:

 

ESTIMATED ANNUAL SALES:

CITY/STATE/ZIP:

 

PHONE:

 

 

 

ACCOUNT #

FEDERAL ID#

 

NAMES OF OWNERS, PARTNERS, PRESIDENT & ACCT. PAYABLE CONTACT

NAME

TITLE

 

 

 

 

 

 

 

 

 

 

 

TRADE REFERENCES

NAME

ADDRESS

PHONE

FAX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BANK INFORMATION

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: ___________________________________