Credit Application

CREDIT APPLICATION
Business Name*
Phone Number*
E-mail*
example@example.com
Website *
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Information
Business Entity Type*
Date of Establishment*

MonthDayYear
Date
Number of Employees
Annual Revenue
Credit Amount Requested*
Expected Monthly Purchase Volume
Accounts Payable Contact*
Account Payable Email *
example@example.com
Account Payable Phone Number*
Please enter a valid phone number.
EIN - Tax Number*
Billing Method*
Documents Required With Invoice, if any:
Will a third party be responsible for paying invoices?*

YesNo
Third-Party Company Name*
Third-Party Contact Name (if applicable)
Third-Party Phone Number*
Please enter a valid phone number.
Third-Party Email*
example@example.com

Banking Information
Bank Name*
Bank Phone Number*
Bank Fax Number
Bank Account Number
Account Type*
Line of Credit (if any)
Contact*
Email*
example@example.com

Business References
Reference 1*
Reference 2*
Reference 3*

Optional Section for the Attachments
Please attach the following documents with your application:

Copy of business license

Financial statements (last two years)

Any other supporting documents
File Upload

Cancelof

Name*

First NameLast Name
Title*
Date*

MonthDayYear
Date
Signature*

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