Credit Application
Company:
Company name is required.
Minimum number of characters not met.
Exceeded maximum number of characters.
Address:
Address is required.
Exceeded maximum number of characters.
City:
City is required.
Exceeded maximum number of characters.
State:
State is required.
Exceeded maximum number of characters.
Minimum number of characters not met.
Zip:
Zip Code is required.
Use 5 digit Zip Code.
Email:
Valid Email address is required.
Invalid format.
Exceeded maximum number of characters.
Phone:
Phone number is required.
Invalid format ((xxx) xxx-xxxx).
Fax:
Invalid format ((xxx) xxx-xxxx).
County:
County is required.
Exceeded maximum number of characters.
Type of Business:
Business Type is required.
Exceeded maximum number of characters.
Date Established:
Date is required.
Invalid format (mm/dd/yyyy).
Select One:
Corporation:
Individual:
Partnership:
You must select one box.
Principals
Name:
Name:
Name:
Address:
Address:
Address:
Credit Limit Desired:
P.O. Required:
YES
NO
Sales Tax Exempt:
YES
NO
Sales Tax Number:
(Applicant must submit a copy of the certificate.)
Trade References
Name:
Name:
Name:
Address:
Phone:
Address:
Phone:
Address:
Phone:
Account:
Fax:
Account:
Fax:
Account:
Fax:
Banks
Name:
Name:
Address:
Phone:
Address:
Phone:
Account:
Fax:
Account:
Fax:
Credit Terms
1. In business a minimum of one year.
2. Established credit references.
3. No charges under $30.
4. No individual credit accounts.
5. No instant credit to anyone.
6. Our terms are Net 30 days.
7. Accounts consistently slow
will be placed on COD.
8. Amounts not paid within the terms
will be subject to a service charge of
1 1/2% per month (18% APR).
Controller (Name):
Signature: _________________________
Date: _________________________
Accounts Payable (Name):
Title:
* MUST BE SIGNED BY THE OWNER, PARTNER, OR AUTHORIZED OFFICER OF THE CORPORATION.
* Press CONFIRM, then print, sign, and fax the application to (704) 376-5522.
