Commercial Credit Application

Commercial Credit Application
Company Information
Company's Legal Name
Doing business as (DBA), If different from Legal Name
Federal ID Number
Fuel Brand
Business Phone Number

Area CodePhone Number
Contact Name
Title
Email
example@example.com
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State of incorporation
Year Incorporated

MonthDayYear
Date
Legal Structure
Gallons Sold/Month
Sales/Month
Years in Business
Years Owned
# of Employees
Legal Name of Owners /Officers/Guarantors
Owner/ Officer/ Guarantor
Title
Email
example@example.com
Social Security Number
Date of Birth

MonthDayYear
Date
% Ownership
Cell Phone Number

Area CodePhone Number
Years in Business
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Legal Name of Owners /Officers /Guarantors

Additional Entry
Owner/ Officer/ Guarantor
Title
Email
example@example.com
Social Security Number
Date of Birth

MonthDayYear
Date
% Ownership
Cell Phone Number

Area CodePhone Number
Years in Business
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank References

(include deposit accounts and loans/lines of credit, if applicable)
Current Request
Vendor /Supplier of Equipment
Contact Name
Contact Phone number

Area CodePhone Number
Total Credit Request
Term
Estimated Project Start Date
Equipment Address (if different than Above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Equipment Description
Required Authorization
Name

First NameLast Name
Title
Date

MonthDayYear
Date
Signature
Required Authorization

Additional Entry
Name

First NameLast Name
Title
Date

MonthDayYear
Date
Signature
ECOA NOTICE (TO Be Retained By APPLICANT)

Thank you for your business credit application. We will review it carefully and get back to you promptly. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain that statement, please contact us within 60 days from the date you are notified of our denial decision. We will send you a written statement of the reasons for the denial within 30 days of your request for the statement.

NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on basis of race, color, religion, national origin, sex, marital status, age (provided the applicants has the capacity to enter into a binding contract); because all or part of an applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. the federal agency that administers our compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.
Should be Empty:

Commercial Credit Application

Company Information

Legal Name of Owners /Officers/Guarantors

Legal Name of Owners /Officers /Guarantors

Bank References

Current Request

Required Authorization

Required Authorization