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CREDIT APPLICATION

Resgistered Trade Name
Phone Number
Fax Number
Business Address
Resale Number
Years In Business
Check One




OWNERS, PARTNERS OR STOCKHOLDERS
Name
Title
Residence Address
Name
Title
Residence Address
Type of Business
Terms





Expected Monthly Credit
BANKING DETAILS
Bank
Branch
Address
Telephone Number
Account Number
TRADE REFERENCES (i.e. Dealers, Wholesalers)
Name
Address
Phone Number
Name
Address
Phone number
Name
Address
Phone Number
Name
Address
Phone Number
We believe that our firm is financially able to meet any committments we have made and we expect to pay your invoices according to your terms. In the event of non-payment we agree to pay in addition to the principal amounts due all collection charges, incurred by Seller, including charges made by a collection agent up to but not exceeding 30% of the principal balance due and, in the event of suit, reasonable attorneys fees and court costs. The undersigned further agrees to pay a service charge at the rate of 1-1/2% per month commencing the first day following due date not to exceed 18% per year.
Application for credit signed by
Date