Garnet Wholesale Parts
Business Credit Application
Name/Address
Name
*
First Name
Middle Initial
Last Name
Title
*
Name of Business
*
Tax ID Number
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
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Company Information
Type of Business
*
In Business Since:
*
Legal Form Under Which Business Operates:
*
Corporation
Partnership
Proprietorship
If Division/Subsidiary, Name of Parent Company:
In Business Since:
Name of Company Principal Responsible for Business Transactions
Title:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Company Principal Responsible for Business Transactions
Title:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
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Bank References
Institution Name:
Checking Account #
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Institution Name:
Savings Account #
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Institution Name:
Home Equity Loan
Loan Balance
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
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Trade References
Company Name:
Contact Name:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Account Opened Since:
Credit Limit:
Current Balance:
Company Name:
Contact Name:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Account Opened Since:
Credit Limit:
Current Balance:
Company Name:
Contact Name:
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Account Opened Since:
Credit Limit:
Current Balance:
Signature
I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: