Fillable Credit Application Form printable pdf download

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9000 Commerce Parkway, Suite B

Mount Laurel, NJ 08054

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Phone: 877-428-4285/856-231-9449

Fax: 856-231-9818

Credit Application

Business Name: ________________________________________________________________________________________

Phone: _______________________ Email: _________________________________

Fax: _________________________

Mailing Address: _____________________________________________________________

For past ______ years

______________________________________________________________

# employees: __________

Accounting Contact: ____________________________________

Accounting phone: ____________________________

Nature of Business: ______________________________ Date Established: ________ Federal Tax ID#: _______________

Individually Owned: ____ Partnership: ____ Corporation: ____ Incorporating State: ______ Aprox. Annual Sales: _________

Has the firm or any of its Principals ever filed for bankruptcy?

Yes_______ No_______

If yes, explain:

_______________________________________________________________________________________

PRINCIPAL:

_______________________________________________________________________________________

(Name)

(Title)

(SS#)

(Home Address)

PRINCIPAL:

_______________________________________________________________________________________

(Name)

(Title)

(SS#)

(Home Address)

BANK REFERENCES:

Checking: _____ Loan: _____ Savings: _____

_____________________________

(Authorizing Signature)

_____________________________________________________________________________________________________

(Bank Name)

(Address/Phone)

Account #)

(Contact)

_____________________________________________________________________________________________________

(Bank Name)

(Address/Phone)

Account #)

(Contact)

TRADE REFERENCES: (Name suppliers of major products and services/other than utilities, rent, phone, etc.)

Name

Address/Phone

_____________________________________________________________________________________________________

TERMS AND CONDITIONS OF SALE UPON EXTENSION OF CREDIT

1) Payment terms are Net 30 Days. 2) IATL reserves the right to charge a 1% finance charge per month on invoices that reach 31 days. 3) If services of an

attorney or collections are employed to collect any portion of this account, there shall be assessed a fee equal to 30% of the amount owed, which is expressly

agreed to be a reasonable collection fee PLUS any and all interest billed or billable. (4) I/We guarantee the payment on ALL ADDITIONAL purchases. I/We

represent that we are authorized to accept these terms and conditions of sale for applicant and that all facts herin are truthful to the best of our knowledge.

CORPORATE SEAL:

Applicant's Signature/Date:

__________________________________________

Name (print) and Title: __________________________________________

Officer's Signature/Date: __________________________________________

Name (print) and Title: __________________________________________

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