Dealer Credit Application

Business Name: *

Mailing Address: *

Street

City State

Zip Code

Telephone: *

Please Check One of The Following: *

Individual Owner Partnership Corporation

Number of Years in Business *

Date Business Started *

Incorporated in What State? *

Street Address

Street Address Line 2

Owners or Executive Offices (Must fill in completely)

Name: *

Title *

Sales Tax Exempt Number *

To validate exemption, submit a copy with this application

Trade Reference 1

Company Name: *

Account Number: *

A/P Contact Email or Fax: *

Trade Reference 2

Company Name: *

Account Number: *

A/P Contact Email or Fax: *

Trade References 3

Company Name: *

Account Number: *

A/P Contact Email or Fax: *

Bank Name: *

Account Number: *

Bank Officer: *

Telephone: *

We hereby apply for credit and affirm financial responsibility, ability and willingness to pay invoices in accordance with Creditor’s published terms. The above information, and any and all attachments, is warranted true, correct and complete. We hereby authorize you to verify and collect information on us, including, but not limited to bank references, trade references, consumer and/or commercial credit reports. We agree to pay a monthly finance charge of the maximum applicable state rate on all past due balances. We agree to pay all costs of collection including reasonable attorney’s fees on this account in accordance with the laws of the creditor’s state of incorporation. We agree that all decisions, with respect to the extension or continuation of credit, shall be in the sole discretion of the Creditor. We further acknowledge and agree that in the event we have ordered customized products from the Creditor, and for any reason cancel such order, we will be responsible for all costs of the artwork incurred in developing such custom products.

Upload Sales Tax Exempt Certificate

Authorized Signature *

Clear

Printed Name *

Date *