"APPLICATION FOR CREDIT"
APPLICATION FOR CREDIT ISSUED TO (NAME OF FIRM Requesting Application) (PLEASE ANSWER ALL QUESTIONS. WHEN NO FIGURES ARE INSERTED, WRITE WORD “NONE”) ESTIMATED ANNUAL PURCHASES OPEN ACCOUNT CREDIT VALUE REQUESTED FIRM NAME TRADE STYLE STREET ADDRESS PHONE CITY STATE ZIP CODE FAX FULL NAME OF OWNER OR OWNERS (OR AN AUTHORIZED OFFICER OF CORPORATION) LIST HOME ADDRESS & ZIP CODE FOR INDIVIDUALS AND PARTNERS IF INDIVIDUAL OR PARTNERSHIP NAME SS# - - Email Address: NAME SS# - - Email Address: PLEASE CHECK ONE INDIVIDUAL PARTNERSHIP CORPORATION FED. ID TAX NO (FOR CORP) - BILL TO ADDRESS: CITY STATE ZIP ADDITIONAL INFORMATION REQUIRED FOR CONDITIONAL SALES CONTRACTS UNDER THE UNIFORM COMMERCIAL CODE AGENT OR CO. REPRESENTATIVE (PERSON SIGNING APPLICATION) (PRINT) TITLE TYPE OF BUSINESS DATE STARTED TOTAL ESTIMATED ANNUAL SALES $ FORMER BUSINESS LOCATION OWN OR RENT BUILDING – IF RENT – FROM WHOM? IF OWN, VALUE $ REAL ESTATE MORTGAGE COMPANY: TRADE REFERENCES NAME ADDRESS TELEPHONE FAX NAME OF BANK BANK CONTACT STREET ADDRESS TELEPHONE CITY STATE APPLICANT’S SIGNATURE ATTESTS FINANCIAL RESPONSIBILITY, ABILITY AND WILLINGNESS TO PAY OUR INVOICES IN ACCORDANCE WITH THE FOLLOWING TERMS: FIRM NAME DATE: SIGNED BY TITLE SIGNED BY TITLE The above information is for the purpose of obtaining credit and is warranted to be true. I/we hereby authorize the firm to whom this application is made to investigate the references listed pertaining to my/our credit and financial responsibility. In addition, the undersigned individual who is either a principal of the credit applicant or owner of the credit applicant (business), 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 from time to time as may be needed, in the business credit evaluation process. Any signed document transmitted by facsimile machine (fax) shall be treated in all manner and respects, as an original document and the signature of any Party upon a document transmitted by fax shall be considered an original signature. 1.) In the event that legal action is required to collect money due for goods and services, purchaser is responsible for and shall pay all collection costs, agency fees, reasonable attorney’s fees and court costs incurred by seller. Interest will be charged on all unpaid, past due amounts owed creditor at the maximum allowed by law within each state. 2.) The parties signing this Credit Agreement may be required to deliver to the creditor a personal guarantee for payment of product or services in order to establish trade credit from the seller. The personal guarantee if required is attached and an integral part of this application. Business Credit Management Association Inc., Wisconsin Approved Creditor’s Form FORMS/2007/CREDITAPP