CREDIT / DEALER APPLICATION Company name DBA (if different) Contact person Address
City
State
Phone
Fax
Website Address:
Email Address:
Federal tax ID or Social Security number
DUNS No
Date business established
No. of employees
Type of Account Requested: Type of Business:
Credit Card □
Corporation □
Net 30 □
Partnership □
Zip
Other Limited Liability Company □
Sole Proprietorship □
Financial Statements / PLEASE FURNISH COPY Fiscal Closing Date
Prior Year End Sales
Interim Sales No. of Months Company Officers/Partners/Owners: Name:
Title:
% Owned
Name:
Title:
% Owned
Name:
Title:
% Owned
TRADE REFERENCES
Reference #1
Name Address Phone
Reference #2
Name Address Phone
Reference #3
Name Address Phone