Credit Application Credit Application Form Credit Application with Terms Company Name * Company Website Corporate Phone * Federal ID * Prior Business Name D&B AP Contact Name AP Contact Phone AP Contact Email Billing Email Billing Preference * - Please Select -EmailPortalOther Portal * Other Billing Preference * Corporate Address Street Address * City * State/Region * Country * Postal Code * Billing Address is the same as Corporate Address Billing Address is the same as Corporate Address Billing Address Billing Street Address * Billing City * Billing State/Region * Billing Country * Billing Postal Code * Trade Reference Credit checks may take up to 10 business days. If we receive a negative response from your trade reference, or no response at all, you will be placed on 100% advance terms. Reference #1 Name * Reference #1 Phone * Reference #1 Email * Reference #1 Company * Reference #1 Address, Country, Postal Code * Trade Reference #2 arrowup6 Reference #2 Name * Reference #2 Phone * Reference #2 Email * Reference #2 Company * Reference #2 Address, Country, Postal Code * Trade Reference #3 arrowup6 Reference #3 Name * Reference #3 Phone * Reference #3 Email * Reference #3 Company * Reference #3 Address, Country, Postal Code * Bank Reference Bank Name * Bank Phone Bank Email Type of Account * Bank Address, Country, Postal Code * Information on Principals Name * Address * Phone * Position * Name Address Phone Position Name Address Phone Position Signature Disclaimer 1 * I/We certify that this information is correct, complete and that we are able to pay within the terms granted. I/We further understand that the Seller will rely on this information for the extension of credit. Disclaimer 2 * I/We authorize the Seller from time to time to obtain Business Credit reports on the company listed above. This is not an agreement by the Seller to lend money; it is an agreement by the Customer for the benefit of the Seller if the Seller determines to extend credit. Seller may change credit limits or other credit terms at any time, in its sole discretion. Disclaimer 3 * Customer agrees that any amount not paid within terms will be subject to interest at a rate of 1.5% per month, and agrees to ay all costs incurred in collection, including attorney’s fees in the amount of 1/3 of the total balance due if this account is place with an attorney for collection, whether suit is filed or not. This Agreement shall be governed and construed in accordance with the laws of the State of Utah. First Name * Last Name * Date * Signature * signature keyboard Clear Submit If you are human, leave this field blank.
