Legal Forms
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Application For Credit
APPLICATION FOR CREDIT
[address]
[phone and FAX numbers]
We are pleased you have selected [Name of credit company] Inc. Below is some basic information we need in order to establish your account. Please complete the form and return or FAX it to [Name of credit company] Inc., attention new accounts.
Company Name: [Name of company]
Phone: [Phone of company]
FAX: [FAX of company]
E-mail [E-mail of company]
Billing Address : [Billing Address]
City: [Billing City]
State: [Billing State]
Zip Code: [Billing Zip Code]
Shipping Address: [Shipping Address]
City: [Shipping City]
State: [Shipping State]
Zip Code: [Shipping Zip Code]
Contact: [Contact]
Type of Business: [Type of Business]
In Business Since: [In Business Since]
Form of Business: [Corporation/LLC/Partnership/Sole Proprietor]
Is a Purchase Order required for work you will have done?
[Is a Purchase Order required for work you will have done?]
Who are the authorized people?
[Who are the authorized people? ]
If it is to be a blanket P.O., Please list the number and expiration date:
To whose attention should invoices be sent?
[To whose attention should invoices be sent?]
Is your work taxable? If not, Please attach proper signed certificate and list your tax exempt or resellers number:
[tax exempt or resellers number]
If you which to pay by Credit Card, Please provide information below:
[VISA/Master Card/American Express]
Card # [Card #]
Exp. Date: [Exp. Date]
Bank References: [List of names and address of local banks]
Trade References: [List of names, address, phone number, and account number of three references. Do not list credit cards]
Our terms are net [Days to pay] days. Accounts not paid in this time frame will be charged [Interest rate per month] % interest rate per month and future orders will be on a C.O.D. basis until the account is current. Should collection or legal action be required to collect past dues, said fees will be added to your account.
Print Name: [Name]
Title: [Title]
Signed by:
Date: [Date]