CREDIT APPLICATION Firm Name: ________________________Contact person: _______________________ Address: _______________________________________________________________
City: ________________________State: _________________Zip: ________________ Type of business: ___________________ Year business opened: __________________
Phone: _________________ Fax: ___________________ Email: __________________ Federal ID# or SS# : _____________________ Principals name: ___________________ Bank Reference
Name: ________________________________ Account #: _______________________ Address: _______________________________________________________________
City: _____________________ State: __________________ Zip: __________________ Phone: ________________________ Date account opened: ______________________ Trade References
Firm name: ____________________________ Phone: ___________________________ Firm name: ____________________________ Phone: ___________________________
Firm name: ____________________________ Phone: ___________________________ The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing
that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above
named business credit grantor, from time to time as may be needed, in the credit evaluation process. Company: ______________________________ Date: _____________________
Signature: ______________________________ Title: ______________________ Please print your name: _______________________________________________ |