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Application For Open Account Credit
APPLICATION FOR OPEN ACCOUNT CREDIT
PHONE : [PHONE]
FAX : [FAX]
ORDERS : [ORDERS]
FIRM NAME : [FIRM NAME]
PHONE : [PHONE]
BILLING ADDRESS : [BILLING ADDRESS]
CITY, STATE, ZIP : [CITY, STATE, ZIP]
SHIPPING ADDRESS : [SHIPPING ADDRESS]
[Individual/Partnership/Corporation]
TYPE OF BUSINESS : [TYPE OF BUSINESS]
YRS. IN BUSINESS : [YRS. IN BUSINESS]
FEDERAL TAX NO. : [FEDERAL TAX NO.]
SOCIAL SECURITY NO. : [SOCIAL SECURITY NO]
PROPRIETOR, PARTNERS OR OFFICERS
NAME : [NAME OF PARTNER 1]
TITLE : [TITLE OF PARTNER 1]
HOME ADDRESS : [HOME ADDRESS OF PARTNER 1]
PHONE NO. : [PHONE NO. OF PARTNER 1]
NAME : [NAME OF PARTNER 2]
TITLE : [TITLE OF PARTNER 2]
HOME ADDRESS : [HOME ADDRESS OF PARTNER 2]
PHONE NO. : [PHONE NO. OF PARTNER 2]
NAME : [NAME OF PARTNER 3]
TITLE : [TITLE OF PARTNER 3]
HOME ADDRESS : [HOME ADDRESS OF PARTNER 3]
PHONE NO. : [PHONE NO. OF PARTNER 3]
INDIVIDUAL RESPONSIBLE FOR PAYMENT OF ACCOUNT
NAME : [NAME OF INDIVIDUAL RESPONSIBLE]
TITLE : [TITLE OF INDIVIDUAL RESPONSIBLE]
BANK REFERENCE
NAME : [NAME OF BANK REFERENCE 1]
ACCT. NO.: [ACCT. NO. OF BANK REFERENCE 1]
ADDRESS : [ADDRESS OF BANK REFERENCE 1]
PHONE : [PHONE OF BANK REFERENCE 1]
CITY : [CITY OF BANK REFERENCE 1]
STATE : [STATE OF BANK REFERENCE 1]
ZIP : [ZIP OF BANK REFERENCE 1]
CONTACT : [CONTACT OF BANK REFERENCE 1]
DUNN & BRADSTREET I.D. NUMBER : [DUNN & BRADSTREET I.D. NUMBER]
TRADE REFERENCES
NAME : [NAME OF TRADE REFERENCE 1]
ACCT. NO.: [ACCT. NO. OF TRADE REFERENCE 1]
ADDRESS : [ADDRESS OF TRADE REFERENCE 1]
PHONE : [PHONE OF TRADE REFERENCE 1]
CITY : [CITY OF TRADE REFERENCE 1]
STATE : [STATE OF TRADE REFERENCE 1]
ZIP : [ZIP OF TRADE REFERENCE 1]
CONTACT : [CONTACT OF TRADE REFERENCE 1]
NAME : [NAME OF TRADE REFERENCE 2]
ACCT. NO.: [ACCT. NO. OF TRADE REFERENCE 2]
ADDRESS : [ADDRESS OF TRADE REFERENCE 2]
PHONE : [PHONE OF TRADE REFERENCE 2]
CITY : [CITY OF TRADE REFERENCE 2]
STATE : [STATE OF TRADE REFERENCE 2]
ZIP : [ZIP OF TRADE REFERENCE 2]
CONTACT : [CONTACT OF TRADE REFERENCE 2]
NAME : [NAME OF TRADE REFERENCE 3]
ACCT. NO.: [ACCT. NO. OF TRADE REFERENCE 3]
ADDRESS : [ADDRESS OF TRADE REFERENCE 3]
PHONE : [PHONE OF TRADE REFERENCE 3]
CITY : [CITY OF TRADE REFERENCE 3]
STATE : [STATE OF TRADE REFERENCE 3]
ZIP : [ZIP OF TRADE REFERENCE 3]
CONTACT : [CONTACT OF TRADE REFERENCE 3]
Applicants signature attests financial responsibility, ability and willingness to pay our invoices in accordance with terms stated below. If any suit or legal action is instituted in connection with any controversy arising out of the estimate, proposal, or any work authorized in connection with same, the prevailing party shall be entitled to recover, in addition to the court costs and disbursements, such sum as the court may adjudge reasonable as attorney fees.
The above information is for the purpose of obtaining credit and is warranted to be true.
[I/We] hereby authorize the firm to whom the application is made to investigate the references listed pertaining to [my/our] credit and financial responsibility.
SIGNED :
[ Company Name.]
BY : [COMPANY OFFICIAL]
POSITION : [POSITION OF COMPANY OFFICIAL]