Business Contact Info
Credit Application for Business Account
Company Name
*
Salesperson Name:
*
Please indicate salesperson name, or "none" if you do not have one.
Phone Number
*
Format: (000) 000-0000.
Fax Number
Format: (000) 000-0000.
E-mail
*
example@example.com
Would you like monthly statements & invoices emailed, mailed or both?
Please indicate mail, email or both
Persons authorized to purchase on this account.
Requested Credit Limit
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Federal ID Number (No Dashes)
*
Company Type
*
Sole Proprietorship
Limited Liability Corporation (LLC)
Partnership
Corporation
Other
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Name
*
First Name
Last Name
Signature
*
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Business and Credit Info
Accounts Payable Contact
*
First Name
Last Name
Accounts Payable Phone
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Name
*
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Business References
You must either fill in information or upload a business reference document for application to be processed.
Please choose how you will provide references:
*
Text boxes (Please fill in information for your 3 business references below.)
Business Reference Sheet Upload (Attach at bottom of this page.)
Reference 1: Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Fax Number
Format: (000) 000-0000.
E-mail
example@example.com
Reference 2: Company Name
Address 2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number 2
Format: (000) 000-0000.
Fax Number 2
Format: (000) 000-0000.
E-mail 2
example@example.com
Reference 3: Company Name
Address 3
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number 3
Format: (000) 000-0000.
Fax Number 3
Format: (000) 000-0000.
E-mail 3
example@example.com
Upload Reference Sheet Here
Browse Files
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Agreement
(By checking these boxes you are agreeing to our terms - should you have any questions please contact us)
Agreement and Terms
*
I hereby authorize Parmenter, Inc. to make any inquiries necessary of the above named business and persons with the given Credit References and Credit Reporting Agencies.
Agreement and Terms
*
The above Business agrees to pay its invoices and statements according to the terms provided to me by Parmenter, Inc.. If my business's related account becomes overdue, the Business further agrees and promises to pay finance charges on the unpaid amount at the rate stated on my invoices and statements. The business further assumes responsibility of all bills contracted in the Business's name at the above address. In the event it becomes necessary for Parmenter, Inc. to incur any costs of collection or costs associated with a collection procedure against my business, the undersigned promises to pay such costs and additional sums as the court may find reasonable.
Agreement and Terms (Required if Business is a Corporation)
In consideration of Parmenter, Inc. extending credit to the aforementioned corporation, the Business, I hereby personally guarantee any and all amounts owed by the Business to Parmenter, Inc. I further agree that upon demand, I shall personally pay all amounts owed by the Business to Parmenter, Inc. In the event it becomes necessary for Parmenter, Inc. to incur any costs of collection procedure against the Business, or the undersigned, the undersigned promises to pay such costs and additional sums as the court may find reasonable.
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Signature
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