LOCO COOKERS - DEALER CREDIT APPLICATION

LOCO COOKERS CREDIT APPLICATION
BUSINESS INFORMATION
Business Name
Business Type

Sole ProprietorshipPartnershipCorporationDistributorDealerBuying Group MemberOther
Proprietor or Partners Names
Registered Company Address

Registered Company Address

Street Address Line 2

CityState

Zip
County
Billing Address

Registered Company Address

Street Address Line 2

CityState / Province

Zip
Phone Number
Year Established
Fax Number
Email
example@example.com
Federal Tax No.
Kind of Business
Number of Employees
Estimated Total Annual Sales
Website
Brick and Mortar Location?*

YesNo
CREDIT INFORMATION
Bank Name
Phone No
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Account Number
TRADE REFERENCES

CREDIT REQUEST
Credit Amount Request

C/C OnlyAmount
*Orders prior to credit approval must be made via credit card

*Credit card transactions will incur a 2.5% fee
Fill and Kill Options(select one)

AutomaticAutomatic at 30 DaysContact at 30 days, Automatic at 60 Days
Should be Empty:

LOCO COOKERS CREDIT APPLICATION