Business Credit Application

Company Information

Company Name:

Company Address:

Telephone:

Email Address:

Owner/Officer Name:

Legal Entity Type:

CorporationPartnershipProprietorship

Federal Tax ID Number:

State Tax Exemption Number:

Bank Name:

Bank Address:

Bank Telephone:

Trade Reference 1:

Trade Reference 2:

Trade Reference 3:

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.

Signed By (Print Full Name):