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Credit Application Example
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Text in this example:
Contact Information Billing Information Contact Name AP Contact Name Company Name Company Name Address Address Phone Phone Fax Fax E-mail E-mail General Company Information Federal Tax ID number Principal Officer Dunn & Bradstreet number Title Legal Structure (check all that apply) o Corporation o LLC o Sole Proprietor o Partnership o LLP o Non-Profit In Business Since Business Type Bank References Bank Name (#1) Bank Acct#/Type Bank Address Bank City/State/Zip Bank Contact Bank Phone Bank Name (#2) Bank Acct#/Type Bank Address Bank City/State/Zip Bank Contact Bank Phone Trade References Company Contact Street City State Phone 1. 2. 3. 4. Signature & Authorization The signature below represents and warrants that (a) the party signing below is an authorized representative of the company; and (b) that the information provided herein is a complete and accurate representation of the company's financial situation as of the date hereof. Any misrepresentation or fraudulent information provided will be the basis for default under this agreement.
By signing this form, I expressly authorize [Your Company Name] to contact the above references to determine credit worthiness. Signature Date Print Name Business Title Credit Application Your Company Your Street Your City, State& Zip Code Your Phone
By signing this form, I expressly authorize [Your Company Name] to contact the above references to determine credit worthiness. Signature Date Print Name Business Title Credit Application Your Company Your Street Your City, State& Zip Code Your Phone