Credit Application Form Salesman*Program*Business InformationComplete Legal Company Name** Corporation Proprietorship Partnership L.L.C. Street Address*City*State*Zip Code*County*Phone #*Cell Phone #*Fax #*Nature of Business*Other Business Names Used*FEDERAL I.D. #*Year Started*D & B #*Ship to LocationStreet Address*City*State*Zip Code*County*Phone #*Fax #*Officers/Owners/PartnersName #1*Title*% Owned*Spouse*% Owned*Residence*Home Phone #*Social Security #*Name #1*Title*% Owned*Spouse*% Owned*Residence*Home Phone #*Social Security #*Has any owner/officer filed for bankruptcy in the last 10 years?*NoYesBank ReferencesBank Name*Phone #*Acct. # (List all)*Contact*Acct. Type*Bank Name*Phone #*Acct. # (List all)*Contact*Acct. Type*Trade ReferencesCompany Name*Phone #*Acct. #*Contact*Company Name*Phone #*Acct. #*Contact*Company Name*Phone #*Acct. #*Contact*Customer Credit ReleaseTHE UNDERSIGNED AUTHORIZES ALL PARTIES CONTACTED TO RELEASE CREDIT AND FINANCIAL INFORMATIONMust be signed:*Date* Date Format: MM slash DD slash YYYY Financial StatementPLEASE ATTACH COPY OF YOUR PREPARED FINANCIAL STATEMENT*YesNoSignature*THE PERSON SIGNING THIS APPLICATION DOES HEREBY WARRANT THAT THEY ARE AUTHORIZED FOR THAT COMPANY FIRST MENTIONED ABOVE.Signature*Date* Date Format: MM slash DD slash YYYY *PLEASE SUBMIT TAX EXEMPTION CERTIFICATION IF APPLICABLE.File
