Company Credit Application Form

Company Credit Application Form

At SurgeFX, we're dedicated to supporting the businesses that create unforgettable experiences. We understand that managing cash flow is critical for production companies, event organizers, installers, and rental houses. That's why we offer Net 30 payment terms to qualified B2B customers.Opening a credit account with us simplifies the ordering process for all your essential gear—from high-output fog machines and CO2 jets to stage lighting and special effect fluids. Enjoy the flexibility of buying now and paying later, making it easier to secure the equipment you need for your next big project.**To apply, please complete the secure form below. The process typically takes 3-5 business days, and we will notify you of our decision via email.**
Company Information
Legal Business Name*
DBA (if applicable)
Entity Type*
Federal Tax ID/EIN*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Years in Business*
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount Requesting*
Contact Information
Contact Name*

First NameLast Name
Contact Email*
example@example.com
Contact Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Banking Information
Bank Name*
Bank Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Bank Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Account Type*
Account # (Last 4 Only)*
Routing # (Last 4 Only)*
Trade References
Reference #1 Company*
Reference #1 Email*
Reference #2 Company*
Reference #2 Email*
Reference #3 Company*
Reference #3 Email*
Upload Reference Docs (PDF, JPG,PNG) (If necessary)

Cancelof
Owners/Officers
Name*

First NameLast Name
Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Personal Guarantee
Guarantor Name*

First NameLast Name
SSN (Last 4 ONLY)*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I agree to the terms and conditions.
Authorized Signature*
Date
Disclaimer & Authorization:

By submitting this credit application, the applicant hereby authorizes SurgeFX to verify all information provided herein and to obtain additional information regarding credit history from any sources necessary, including but not limited to banks, trade references, and credit reporting agencies. The applicant understands that this application is subject to approval at the sole discretion of SurgeFX and that credit terms may be modified, suspended, or revoked at any time based on payment history or changes in financial condition.

All invoices are due and payable according to the agreed payment terms. Past due balances may be subject to finance charges. The undersigned further agrees to be personally liable for all unpaid amounts under this application in accordance with the Personal Guarantee section above.
Should be Empty:

Company Credit Application Form

Company Information

Contact Information

Banking Information

Trade References

Owners/Officers

Personal Guarantee