Business Credit Application

Business Credit Application

Name/Address

Last:

First:

Name of Business:

Address: City:

State:

ZIP:

Middle Initial:

Title Tax I.D. Number

Phone:

Company Information

Type of Business:

Legal Form Under Which Business Operates:

Corporation

If Division/Subsidiary, Name of Parent Company:

In Business Since:

Partnership

In Business Since:

Name of Company Principal Responsible for Business Transactions:

Title:

Address:

City:

State:

ZIP:

Phone:

Name of Company Principal Responsible for Business Transactions:

Title:

Address:

City:

State:

ZIP:

Phone:

Proprietorship

Bank References

Institution Name: Checking Account #: Address:

Institution Name: Savings Account #: Address:

Institution Name: Home Equity Loan: Address:

Loan Balance:

Phone:

Trade References

Company Name: Contact Name: Address:

Phone:

Company Name: Contact Name: Address:

Phone:

Company Name: Contact Name: Address:

Phone: Account Opened Since: Credit Limit: Current Balance:

Phone: Account Opened Since: Credit Limit: Current Balance:

Phone: Account Opened Since: Credit Limit: Current Balance:

I hereby certify that the information contained herein is complete and accurate. 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 financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein.

_________________________________________________________

Signature

______________________________________

Date

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