CREDIT APPLICATION FOR OPEN ACCOUNT

CREDIT APPLICATION FOR OPEN ACCOUNT

Attach Sales Tax # and Certificate if Applicable
BUSINESS CONTACT INFORMATION
Name/Title
Owners
Company name
Company Phone
Format: (000) 000-0000.
Company Fax
Please enter a valid phone number.Format: (000) 000-0000.
Company Email
example@example.com
Registered Company Address
City
State
Zip Code
Federal ID#/SS#
Credit Line Requested?
Accounts Payable Contact
Accounts Payable Phone
Format: (000) 000-0000.
Preferred Billing Method
Purchase Order Required
Type of Haul or Business
BUSINESS AND CREDIT INFORMATION
Annual gross income
Annual net income
Bank Name
Contact person
Contact person Phone
Format: (000) 000-0000.
Fax
Please enter a valid phone number.Format: (000) 000-0000.
Bank Address
City
State
Zip
Type of Account:
Savings Account Number
Checking Account Number
Other Account Number
BUSINESS/TRADE REFERENCES
Company name
Address

Address

Street Address Line 2

City State ZipState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Fax
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Type of account
Company name
Address

Address

Street Address Line 2

City State ZipState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Fax
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Type of account
Company name
Address

Address

Street Address Line 2

CityStateZipState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Fax
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Type of account
AGREEMENT
The net due date for all parts, service and equipment is on or before the 10th of each month following date of purchase. Purchases not paid by the net due date are past due and subject to a LATE CHARGE/FINANCE CHARGE. You may pay all charges due on your account with no FINANCE CHARGE if your payment is received by the 10th day of each month following the date of your purchase. Any balance not paid by the 10th day of the month following the date of your purchase will be assessed a LATE CHARGE/FINANCE CHARGE from the due date at a periodic rate of 1.5% per month (Annual Percentage Rate of 18% By signing below, I acknowledge and accept your terms of payment and I authorize you to check our credit as well as exchange information about our company with other vendors.
Company Name
By authorized signer
Date

MonthDayYear
Date
Should be Empty:

CREDIT APPLICATION FOR OPEN ACCOUNT

BUSINESS CONTACT INFORMATION

BUSINESS AND CREDIT INFORMATION

Type of Account:

BUSINESS/TRADE REFERENCES

AGREEMENT