Credit & Trade References Form

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Text in this Example:

Contact Information
Billing Information
Contact Name
AP Contact Name
Company Name
Address
Phone
Fax
E-mail
General Company Information
Federal Tax ID number
Principal Officer
Dunn & Bradstreet number
Title
Legal Structure (check all that apply)
Corporation
LLC
Sole Proprietor
Partnership
LLP
Non-Profit
State Tax ID #
Cal Corp. #
Reseller #
SIC Code
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)
Trade References
Company
Contact
Street
City
State
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 & Trade References
Your Company
Your Street
Your City, State& Zip Code
Your Phone