LOGO   Date: 02-04-2012
  Time: 03:02:44
  IP: 38.107.179.222
   
ONLINE CREDIT APPLICATION APPLICATION
 
Applicatnt Name Credit Limit Required
 
Tax/SS No. License Number
 
Type of Business
 
Corporation Proprietorship Partnership  
Year Of Establishment
 
Full Firm name Primary Phone
 
Billing Address
Primary Fax
Primary Email
Corporate URL
 
Name of Owner or Principle ( if Individual or Partnership, List SS No. & Full Home Address )
 
Resale Number Primary Bank Name
 
Primary Bank Address
Bank Phone Number
Bank Account Since
Bank Contact Officer
 
Account Number
Borrowing Non-Borrowing
 
Listed and Rated in Dun & Bradstreet ? YES NO
 
TRADE REFFRENCES
Please provide at least 2 verifable trade references-(Firm Name, Contact Person, Address, Phone)
I Agree to abide by all the terms and conditions
Release and Terms
 
The undersignd, acting as duly authorized agen/representative for the above named company, certify that information contained on this
application is true the best of his/her knowledge. The Company Name trade terms are net payment in full of all invoices within 30 days
of the billing date. In the event that it becomes necessary for The Company Name to refer an account to a collection agency or attorney to
enforce payment, all reasonable legal fees are aplicable and allowable service change will be paid in full by the debator company.
 
 
 
 
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