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?* No Yes Bank 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* MM slash DD slash YYYY Financial StatementPLEASE ATTACH COPY OF YOUR PREPARED FINANCIAL STATEMENT* Yes No Signature*THE PERSON SIGNING THIS APPLICATION DOES HEREBY WARRANT THAT THEY ARE AUTHORIZED FOR THAT COMPANY FIRST MENTIONED ABOVE.Signature*Date* MM slash DD slash YYYY *PLEASE SUBMIT TAX EXEMPTION CERTIFICATION IF APPLICABLE.FileMax. file size: 200 MB.
