Credit Application
Our Credit Application is designed to provide your company with a streamlined and flexible purchasing experience. By establishing a credit account, you can enjoy convenient net 30 payment terms.
Name of Business
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Fax Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Tax I.D. Number
*
Company Information
Please provide detailed information about your business
Type of Business
*
In Business Since
*
-
Month
-
Day
Year
Date
Legal Entity
*
C Corporation
S Corporation
LLC Corp
LLC Partnership
Partnership
Proprietorship
Other
If Division/Subsidiary Please Provide Name of Parent Company
Parent Company In Business Since
-
Month
-
Day
Year
Date
Name of The Company Principal Responsible for Business Transactions
*
First Name
Last Name
Title of Principal
*
Address of Principal
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Principal
*
Format: (000) 000-0000.
Name of Accounts Payable Contact
*
First Name
Last Name
Address of Accounts Payable
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number of Accounts Payable
*
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like invoices emailed
*
Yes
No
If yes, please provide email address
*
example@example.com
Resale of goods purchased? If yes, please upload a copy of resale certificate. Failure to provide certificate will result in adding sales tax to all invoices.
*
Yes
No
Bank References
Bank References
Institution Name
*
Checking Account Number
*
Institution Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Institution Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Savings Account Number
Same as Checking?
Yes
No
If no, Institution Name
If no, Institution Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If no, Institution Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Trade References
Please provide three trade references with whom you maintain active credit terms. Do not include utilities, credit cards, bank loans, or similar accounts.
Trade Reference 1
*
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Account Opened Since
*
-
Month
-
Day
Year
Date
Credit Limit
*
Trade Reference 2
*
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Account Opened Since
*
-
Month
-
Day
Year
Date
Credit Limit
*
Trade Reference 3
*
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Account Opened Since
*
-
Month
-
Day
Year
Date
Credit Limit
*
Authorization and Acknowledgements
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, by submitting this application, you authorize Everything Safety LLC to make inquiries into banking and business/trade references that you have supplied. TERMS ARE NET 30. All invoices are to be paid 30 days from the date of the invoice to Everything Safety LLC 3320 2nd Ave West Williston ND 58801. Finance charges will be applied at 1.5% or 18% annual. Unpaid amounts will be turned over to collection. Any or all collection/attorney fees will be the responsibility of the business named on this application and the undersigned.
Check Box Below to Acknowledge The Above
*
I acknowledge
Printed Name
*
First Name
Last Name
Today's Date
*
-
Month
-
Day
Year
Date
Submit Application
Should be Empty: