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Business Credit Application

Company Name:

Billing Address:

Phone:____________ Fax:________ Email: _________________

Corporation_____ Partnership _____ Proprietorship ______

Type of Business_______________ Year Established _______

Yearly Gross Sales $___ Yearly Net Profits $___ Net Value

$___ Names and address of Owners, partners, or officers:

Name _____________ Tax I.D. #_____________ Title________

Address:

Name ___________ Tax I.D. #________________ Title________

Address:

CREDIT REFERENCES:

Creditor Name __________ Account #_______ Phone #________

Address:

Creditor Name __________ Account #_______ Phone #________

Address:

Creditor Name __________ Account #_______ Phone #________

Address:

TRADE CREDIT REFERENCES

Vendor Name______________ Account #_________ Phone #______

Address:

Vendor Name______________ Account #_________ Phone #______

Address:

Vendor Name______________ Account #_________ Phone #______

Address:

BANK REFERENCES

Bank Name______________ Account #_________ Phone #_______

Address:

Bank Name______________ Account #_________ Phone #_______

Address:

Bank Name_____________ Account #_________ Phone #_______

Address:

CREDIT LIMIT REQUESTED: $

Credit Terms:

Payment on all invoices is due within [--] days of invoice date.

All overdue invoices bear interest at [--%] per month on unpaid balance.

Credit applicant agrees to pay all costs of collection, including court costs and attorney fees.

Credit terms and limit may be cancelled or changed by Creditor at any time without notice.

All transactions are governed by the laws of the Creditor's state.

All transactions are governed by the terms of the Creditor's documents.

The Credit applicant accept the above terms and states that all information contained in this credit application is true and correct. Credit applicant authorises creditor to contact all references, inquire as to credit information, and receive any confidential information relevant to approving credit.

The credit applicant agrees and acknowledges the signing of this document at the registered office of (name of creditor), located at (address),

City of ________________, State ______________, Zip ____.

Dated:

______________________________

(Signature of Credit Applicant)

By:___________________________

(Name and title of Credit

Applicant)