Customer Credit Application

Customer Credit Application
Date*

MonthDayYear
Date
Business Information
Company Name*
FEIN or SSN*
Type of Business*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nature of Business*
Date Business Started or Incorporated*

MonthDayYear
Date
Owner or Officer Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Owner/Officer Email*
example@example.com
Has the company ever filed bankruptcy?*

YesNo
If yes, enter date

MonthDayYear
Date
Has the company had any tax liens filed against it?*

YesNo
If yes, enter date

MonthDayYear
Date
Invoice Information
Amount of Credit Requested*
Accounts Payable Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Where Invoices Should Be Sent*
example@example.com
Billing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you require a Purchase Order on invoices?*

YesNo
Is the company tax exempt?*

YesNo
If yes, attach certificate here

Cancelof
Credit Reference
Bank Name
Bank Email
example@example.com
Phone Number
Please enter a valid phone number.
Name on Account
Account Number
Trade/Supplier 1 Name
Trade/Supplier 1 Email
example@example.com
Trade/Supplier 1 Phone Number
Please enter a valid phone number.
Trade/Supplier 2 Name
Trade/Supplier 2 Email
example@example.com
Trade/Supplier 2 Phone Number
Please enter a valid phone number.
Trade/Supplier 3 Name
Trade/Supplier 3 Email
example@example.com
Trade/Supplier 3 Phone Number
Please enter a valid phone number.
Terms of Credit
·         All invoices are payable in “NET 30” days. Any other terms must be agreed upon by Adobe Rock and the customer in advance and must be in writing.

·         If an invoice is incorrect, the customer must notify Adobe Rock within 30 days of the invoice date to be corrected.

·         A finance charge of the greater of $35 or 1.5% of the outstanding balance will be assessed per month on all past due invoices.

·         Customer accounts with invoices that remain unpaid after 60 days from the date of the invoice will be considered as cash accounts (payment due at time of order) until the account is brought current.

·         Customer accounts with invoices that remain unpaid after 90 days from the date of the invoice will be forwarded to a collection agency. At that time, all collection fees will be assessed to the account and the account will remain closed until the account has been paid. Adobe Rock will also secure any property liens as needed.
We understand and confirm the terms of credit set forth in this application and hereby accept them as stated.*

Confirm
Name*

First NameLast Name
Title*
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Customer Credit Application

Business Information

Invoice Information

Credit Reference

Terms of Credit