Credit Application

Credit Application Form

BUSINESS INFORMATION

Company Name

Ship To Address

Ship To City/State/Zip:

Bill To Address

Bill To City/State/Zip

Date Business Established:

FED#

TBA Salesman

Request COD or Credit?

Credit Limit Requested

Tax Exempt? (If so, attach exemption form)

Has the business or its principals ever filed bankruptcy?

Email Statement?

If Yes what Email

Accounts Payable Name

Phone

PRINCIPAL OWNER INFORMATION

Name and Title

Home Address/City/State/Zip

Cell Phone

Home Phone

BANK REFERENCES

Bank Name

Phone

Contact

CREDIT REFERENCES

Business Name

Phone

Contact

Business Name

Phone

Contact

Business Name

Phone

Contact

SHOP MANAGEMENT SYSTEM

Shop Management System

TAX EXEMPTION CERTIFICATE

Upload Tax Exemption Certificate as only PDF