Credit Application

1
Name* This field is required.Please enter the name of the individual completing this form.
First Name
Last Name
2
Business Name & Address* This field is required.
Business Name or DBA
Address
City
Please Select
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Zip Code
3
Business ContactType phone # with NO spaces or hyphens
Business Phone
Business Fax (if applicable)
Business Email
Please Select
Please Select
Mail
Email
Fax
Invoice Statement Preference
Primary AP Contact
4
Business Information* This field is required.Enter detailed information about your business.
Year Business Commenced
Federal ID Number (Enter '0' if N/A)
Type of Business
Please Select
Please Select
YES
NO
Tax Exempt
Amount of Credit Requested
5
Type of Account* This field is required.Plese Select What Type of Account You Would Like to Apply For.
COD/Credit Card on Account
Credit Terms
6
Trade ReferencesContinue with an Online Form, or Choose to Upload References.
Continue with Online Form
Upload Trade References
7
Business/Trade Reference Letters UploadPlease upload at least 3 company references that include Name, Full Address, Phone, Email, and Type of Account. PDF files only.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Company References
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8
Business/Trade Reference 1* This field is required.Company References that include Name, Full Address, Phone, and Email.
Reference 1 - Name
Reference 1 - Phone
Reference 1 - Address
Reference 1 - City
Reference 1 - State
Reference 1 - Zip Code
Reference 1 - Email
9
Business/Trade Reference 2* This field is required.Company references that include Name, Full Address, Phone, and Email.
Reference 2 - Name
Reference 2 - Phone
Reference 2 - Address
Reference 2 - City
Reference 2 - State
Reference 2 - Zip Code
Reference 2 - Email
10
Business/Trade Reference 3* This field is required.Company references that include Name, Full Address, Phone, and Email.
Reference 3 - Name
Reference 3 - Phone
Reference 3 - Address
Reference 3 - City
Reference 3 - State
Reference 3 - Zip Code
Reference 3 - Email
11
Principal Officers* This field is required.
President/CEO
Vice President
Secretary
Title
Address
City
State
Zip Code
12
Business/Finance References* This field is required.
Bank Name
Account Number
Address
City
State
Zip
13
Please select 'AGREE' or 'DISAGREE' if you agree to the following terms:1. All invoices are to be paid Net 30 days from the date of Hole Products' invoice via paper check, ACH/EFT or Electronic Check. Credit cards are accepted at the time of purchase Only. Credit Card payments received after the date of purchase will incur a 3% surcharge. 2. Claims arising from invoices must be made within seven work days. 3. I hereby certify that the information contain herein is complete and accurate to the best of my knowledge. 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, I hereby authorize the banking and business/trade references listed in this credit application to release necessary information to Hole Products.* This field is required.
AGREEDISAGREE
14
Signature* This field is required.Using your mouse, please sign below to indicate you are a real person:
Should be Empty: