Credit Application
Company Information:
*
Company Name
Contact Name
First Name
Last Name
Email
example@example.com
Company Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long in business?
*
Months, Years
Business Structure:
*
Corporation
LLC
Partnership
Individual
Credit Request:
*
Product(s) to Be Ordered:
Requested Credit Line:
Purchase Orders Required?
*
Yes
No
Business Principals 1:
*
Business Principal Full Name:
Address:
Telephone:
Business Principals 2:
*
Business Principal Full Name:
Address:
Telephone:
Bank Reference:
*
Bank Name:
City/State:
Telephone:
Account #:
Trade Reference 1:
*
Name:
City/State:
Telephone:
Email
*
example@example.com
Trade Reference 2:
*
Name:
City/State:
Telephone:
Email
*
example@example.com
Trade Reference 3:
*
Name:
City/State:
Telephone:
Email
*
example@example.com
I hereby certify that the above information is true to the best of my knowledge, and I accept C&G's payment terms of Net 30 days. I acknowledge and agree that a finance charge of 1.5% per month will be added to any balance over 30 days old.
*
Submit
Should be Empty: