CREDIT APPLICATION

CREDIT APPLICATION
GENERAL INFORMATION
Applicant Legal Name*
Company Name (or dba)*
In business since*
FED Taxpayer ID*
Business License #*
Business Address*
Business City*
Business State*
Business ZIP Code*
Your Email*
example@example.com
Company Phone*
Company Fax
AP Contact Name*
AP Contact Title*
AP Contact Email*
example@example.com
Do you*

OwnRentLease
Business Type*

ProprietorshipPartnershipCorporation
Past Operation Name (If Any)
OWNER, PARTNERS OR CORPORATE OFFICERS (COMPLETE BELOW)
Name*
Driver License*
Title*
State*
SSN*
Home Phone*
Home Address*
City & State*
Zip*
Is there another owner, partner, or corporate officer that you want to add?*
Name
Driver License
Title
State
SSN
Home Phone
Home Address
City & State
Zip
Is there another owner, partner, or corporate officer that you want to add?
Name
Driver License
Title
State
SSN
Home Phone
Home Address
City & State
Zip
CREDIT REFERENCES (PLEASE COMPLETE ALL FIELDS)
Firm Name*
Address*
City*
State*
Zip*
Email*
example@example.com
Phone*
Please enter a valid phone number.
Fax
Please enter a valid phone number.
Is there another credit reference that you would like to add?
Firm Name
Address
City
State
Zip
Email
example@example.com
Phone
Fax
Is there another credit reference that you would like to add?
Firm Name
Address
City
State
Zip
Email
example@example.com
Phone
Fax
CREDIT REFERENCES - BANK
Bank Name*
Account #*
Type a question*

CheckingSavings
Address
Additional Bank Reference
Bank Name
Account #
Total Approximate Sales per Year*
Estimated Yearly Purchases*
Minimum Initial Credit Line Requested*
WE HEREBY CERTIFY THE FOREGOING TO BE TRUE AND AGREE TO THE ABOVE TERMS

Applicant hereby agrees to pay for goods or services and interest at the highest legal rate per month on all overdue accounts. Should it become necessary to file suit to enforce payment, applicant agrees that such suit may be brought in Orange County, California, at seller's option, and that seller shall be entitled to court costs and attorney fees. The contract and all subsequent purchases are deemed made and are payable at seller's principal place of business shown above. The undersigned authorizes the release of credit information as requested by seller.
SIGNATURE OF APPLICANT*

Clear
Title*
Date*

MonthDayYear
Date
PERSONAL GUARANTEE

For valuable consideration given or to be given, the undersigned hereby personally guarantees to pay all indebtedness or liability incurred in the name of the applicant firm without qualifica- tion or limitation. This is a continuing guarantee and shall continue so long as credit is extended. The guarantee may only be terminated by written notice to seller's credit department sent by certified mail or with signed acknowledgement of receipt. The undersigned waives notice of default, diligence, resort to security, joinder of debtor, or obligation to proceed first against debtor.
Signature of Individual Guarantor below*

Clear
Date*

MonthDayYear
Date
Should be Empty:

CREDIT APPLICATION

GENERAL INFORMATION

OWNER, PARTNERS OR CORPORATE OFFICERS (COMPLETE BELOW)

CREDIT REFERENCES (PLEASE COMPLETE ALL FIELDS)

CREDIT REFERENCES - BANK

Additional Bank Reference