Confidential Credit Application for a Business Account

Choose Service Partner: *

Title *

First Name *

Last Name *

Legal Company Name *

Date business commenced * +

Registered company address *

City *

State *

Zip Code *

Business Type *

What type? *

Business and Credit Information

Primary Business Address *

How long at address? *

City *

State *

Zip Code *

Phone Number *

Primary Email *

Bank Name *

Bank Address *

City *

State *

Zip Code *

Bank Phone Number *

Account Type *

Account Type? *

Account Number *

Business/Trade References

Do you have a document listing your references? *

Yes

No

Please attach your Business References 🛈

1st Reference Company Name *

Type of Account *

Street Address *

City *

State *

Zip Code *

Contact Phone Number *

Contact Email Address *

2nd Reference Company Name *

Type of Account *

Street Address *

City *

State *

Zip Code *

Contact Phone Number *

Contact Email Address *

3rd Reference Company Name *

Type of Account *

Street Address *

City *

State *

Zip Code *

Contact Phone Number *

Contact Email Address *

Agreement

1. All invoices are to be paid upon receipt of the invoice.

2. Claims arising from invoices must be made within seven working days.

3. I hereby certify that the information contained herein is complete and accurate. The information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained here in.

Primary Signature *

clear

Date * +

Secondary Signature *

clear

Name *

Title *

Date * +