Usa Credit Application Form Page 2
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1
2USA CREDIT APPLICATION
REFERENCES
Bank _________________________________________
Trade Reference #1
Branch ________________________________________
Business Name _________________________________
Address _______________________________________
Contact Name __________________________________
City __________________________________________
Address _______________________________________
State ___________ Zip Code ____________________
City __________________________________________
Phone ________________________________________
State ___________ Zip Code ____________________
Fax __________________________________________
Phone ________________________________________
Bank Account # _________________________________
Fax __________________________________________
Bank Contact __________________________________
Email _________________________________________
Trade Reference #2
THIS IS NOT A PERSONAL GUARANTEE
Business Name _________________________________
Contact Name __________________________________
I hereby represent that I am authorized to submit
Address _______________________________________
this application on behalf of the customer
named above, and that the information provided
City __________________________________________
is for the purpose of obtaining credit and is
warranted to be true. I/We hereby authorize Geo.
State ___________ Zip Code ____________________
Bezdan Sales Ltd. to investigate the references
Phone ________________________________________
listed pertaining to my/our credit and financial
responsibility. It is agreed and understood that
Fax __________________________________________
all necessary collection and legal expenses and
Email _________________________________________
interest may be charged to debtor in the event
of default or failure to pay for goods sold and
Trade Reference #3
delivered. I further represent that the customer
Business Name _________________________________
applying for credit has the financial ability and
willingness to pay all invoices with established
Contact Name __________________________________
terms.
Address _______________________________________
City __________________________________________
Signature ________________________________
State ___________ Zip Code ____________________
Name ____________________________________
Phone ________________________________________
Title _____________________________________
Fax __________________________________________
Date _____________________________________
Email _________________________________________
FOR OFFICE USE ONLY
Credit Approved
o Yes
o No
Comments ____________________________________
Credit Limit ____________________________________
______________________________________________
Signed ________________________________________
______________________________________________
Date __________________________________________
______________________________________________
2
1-800-663-6356 •
04/15
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