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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 ______________, Zipcode ____.

Dated:

______________________________

(Signature of Credit Applicant)

By:___________________________

(Name and title of Credit

Applicant)