DM Credit Application Form

DeskMakers Credit Application Form

Please complete the application. Fields marked * are required. You will receive a confirmation email upon submission.
APPLICANT COMPANY INFORMATION
Company Name*
Full legal name (and d/b/a name, if applicable)
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Federal Tax ID#*
enter without "-"
DUNS #
CorporationProprietorshipPartnershipLLC
Date of Incorporation*
MM/DD/YYYY
State of Incorporation*

Street Address

Street Address Line 2

CityState

Zip Code
Requestor Name*
E-mail*
Finance Contact Name*
E-mail*
President/CEO Name*
E-mail*
BANK REFERENCE
Bank Name*
Account Number*
Bank Address*

Street Address

Street Address Line 2

CityState

Zip Code
Bank Contact*
Contact Phone*

Area CodePhone Number
TRADE CREDIT REFERENCES

Please submit 3 current trade references supplying similar goods
1. Trade Reference Name*
1. Account Number
1. Trade Reference Address

Street Address

Street Address Line 2

CityState

Zip Code
1. Trade Reference Contact*
1. Trade Contact Phone*

Area CodePhone Number
2. Trade Reference Name*
2. Account Number
2. Trade Reference Address

Street Address

Street Address Line 2

CityState

Zip Code
2. Trade Reference Contact*
2. Trade Contact Phone*

Area CodePhone Number
3. Trade Reference Name*
3. Account Number
3. Trade Reference Address

Street Address

Street Address Line 2

CityState

Zip Code
3. Trade Reference Contact*
3. Trade Contact Phone*

Area CodePhone Number
CREDIT TERMS AND CONDITIONS

Applicant warrants that the above information is true and accurate. I/we hereby authorize DeskMakers, Inc. to contact the references to investigate Applicant’s credit and financial responsibility. I certify that on behalf of Applicant, I am familiar with the terms shown on “Terms and Conditions of Sale” page on DeskMakers' website, and that failure to abide by the terms and conditions may result in interest and/or late fees being assessed to Applicant’s account.
Authorized Signature*
Type Your Name
Date*
Should be Empty:

DeskMakers Credit Application Form