Credit Application Form printable pdf download

Credit Application

Company Information

Full Legal Business Name: ___________________________________________________________________________

Billing Address: ______________________________________________City: ____________ State: ____ Zip: ________

Phone #: ____- ____ - _____ Fax #: ____- ____ - _____ Social Security # or Federal Tax ID # _____________________

Number of Years in Business ____ Purchase Order Required ____ Special Billing Info ____________________________

Y/N

Type of Business: ___ Non Profit ___Proprietorship ___ General or Limited Partnership ___Corporation

____ State where incorporated (if applicable)

Bank Reference

Name: ___________________________________ Phone #: ____- ____ - _____Account Number: _________________

Address: ____________________________________________________City: ____________ State: ____ Zip: _______

Two Current Vendors/Suppliers

Name: ___________________________________ Phone #: ____- ____ - _____Contact Name: ___________________

Address: ____________________________________________________City: ____________ State: ____ Zip: _______

Name: ___________________________________ Phone #: ____- ____ - _____Contact Name: ___________________

Address: ____________________________________________________City: ____________ State: ____ Zip: _______

________________________________________ ________________________________

_________

Signature

Title

Date

Personal Guarantee

In order to receive credit, I, _______________________________________hereby personally guarantee payment on the

Print Name

account for ____________________________________. Should the company not pay as agreed, I understand that I will

Printed Company Name

be liable for the full balance as well as any costs that may be incurred in attempting to collect past due debts.

____________________________________________________ ______________________ ____ _____________

Personal Address

City

State

Zip

____- ____ - _____

__________________________________

Phone Number

Social Security Number

The undersigned hereby certifies that the foregoing statement is a true and correct statement and that it is submitted for the purpose of procuring credit.

Terms of payment, should credit be granted, shall be in full net thirty days from date of invoice. Amounts past thirty days will be assessed a finance

charge of 1.5% per month (minimum charge 50 cents). If referred to a collections agency, the collection agency’s fee (not to exceed 50%), court costs

and attorney’s fees will be deemed owed in addition to the original amount.

________________________________________

_________

Signature

Date

PO Box 4267 • Englewood, Colorado 80155-4267 USA • Phone 303-779-4035 • Toll-Free 800-333-7262

Fax 303-779-4315 • Email • Website