CREDIT APPLICATION Date: ____________________________________ Applicant Name: ________________________________________________________________ Product Line: __________________________________________________________________ Amount of Credit Requested:______________________________________________________ Company Name: ________________________________________________________________ Doing Business As:_______________________________________________________________ Sold to Address:_________________________________________________________________ Country:_________________ City:____________________ State: _____________ Zip:________
How many Years in Business: ___________________ Fax: _______________________________________ Website: __________________________________ Phone: ____________________________________ D & B#: ____________________________________ Corporation Charter #: ________________________
COMPANY TYPE: (PLEASE CHECK ONE)
[ ] Solo Proprietorship [ ] Partnership [ ] LLC [ ] Corporation [ ] S Corporation
BILLING ADDRESS:
SHIPPING ADDRESS:
Name: ___________________________ Address: _________________________ _________________________ Country: _________________________ City:_____________________________ State: _____________ Zip:___________ Phone: (_____)____________________ Fax: (_____)_______________________
Name: ___________________________ Address: _________________________ _________________________ Country: _________________________ City:_____________________________ State: _____________ Zip:___________ Phone: (_____)____________________ Fax: (_____)_______________________ Vat Registration: ___________________