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Application For Open Account Credit For Stocking Dealers
APPLICATION FOR OPEN ACCOUNT CREDIT FOR STOCKING DEALERS
[Name of Corporation]
[Address of Corporation]
COMPANY NAME : [COMPANY NAME]
PHONE # : [PHONE]
D / B / A : [DOING BUSINESS AS]
FAX # : [FAX]
BILLING ADDRESS : [BILLING ADDRESS]
SHIPPING ADDRESS : [SHIPPING ADDRESS]
PHONE # : [PHONE]
FAX # : [FAX]
OWNER : [OWNER]
SALES TAX # : [SALES TAX]
BUYER : [BUYER]
STORE SIZE : SQ. FT. [STORE SIZE]
BOOKKEEPER : [BOOKKEEPER]
# OF EMPLOYEES : [# OF EMPLOYEES]
HOW LONG IN BUSINESS UNDER CURRENT OWNER : [HOW LONG IN BUSINESS]
PURCHASE SUBJECT TO SALES TAX ? [PURCHASE SUBJECT TO SALES TAX ?: YES/NO]
PURCHASE ORDERS REQUIRED ? [PURCHASE ORDERS REQUIRED ? YES/NO]
LINE OF CREDIT REQUESTED : $ [AMOUNT OF CREDIT REQUESTED]
TYPE OF COMPANY : [TYPE OF COMPANY: SOLE PROPRIETORSHIP/PRIVATE CORP./PARTNERSHIP/PUBLIC CORP./OTHER]
TYPE OF BUSINESS : [TYPE OF BUSINESS: ANTIQUES/CATALOG/FLORIST/GIFTS/DEPARTMENT STORE/FURNITURE/OTHER]
BANK CONTACT : [NAME OF BANK CONTACT]
PHONE # : [PHONE OF BANK CONTACT]
BANK BRANCH : [BANK BRANCH OF BANK CONTACT]
FAX # : [FAX OF BANK CONTACT]
BANK ADDRESS : [BANK ADDRESS OF BANK CONTACT]
ACCT. # : [ACCT. #]
TRADE REFERENCES
COMPANY : [COMPANY OF TRADE REFERENCE 1]
PHONE # : [PHONE OF TRADE REFERENCE 1]
ADDRESS : [ADDRESS OF TRADE REFERENCE 1]
FAX # : [FAX OF TRADE REFERENCE 1]
COMPANY : [COMPANY OF TRADE REFERENCE 2]
PHONE # : [PHONE OF TRADE REFERENCE 2]
ADDRESS : [ADDRESS OF TRADE REFERENCE 2]
FAX # : [FAX OF TRADE REFERENCE 2]
COMPANY : [COMPANY OF TRADE REFERENCE 3]
PHONE # : [PHONE OF TRADE REFERENCE 3]
ADDRESS : [ADDRESS OF TRADE REFERENCE 3]
FAX # : [FAX OF TRADE REFERENCE 3]
COMPANY : [COMPANY OF TRADE REFERENCE 4]
PHONE # : [PHONE OF TRADE REFERENCE 4]
ADDRESS : [ADDRESS OF TRADE REFERENCE 4]
FAX # : [FAX OF TRADE REFERENCE 4]
To the best of my knowledge the above facts are represented as true. I am aware that falsification of any of this information may result in denial of credit by [Name of credit corporation] Inc.. My signature below indicates my permission for [Name of corporation] Inc., to obtain credit information from the sources I have referenced, including any external credit reporting source, and any consumer credit agency. I understand that interest will be charged on all past due balances at a rate of [Past due interest rate] % per month.
AUTHORIZED INDIVIDUAL SIGNATURE DATE
[NAME OF AUTHORIZED INDIVIDUAL]