Credit Application

Business Information

Company
Registered Company Address
City
State	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming AA - Armed Forces Americas AE - Armed Forces Europe AP - Armed Forces Pacific American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands
Zip		12345 or 12345-6789
Phone Number		Phone number is in an invalid format.
Fax Number
E-Mail Address		email@domain.com ( or .net, .org, etc. )
Year Established
Type of Company	Choose a Type Sole Owner Partnership Corporation Other (See Below)
Type of Company (Other)
Tax Resale ID

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Business Contact Information

My contact information is the same as my business information.

Billing Address
City
State	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming AA - Armed Forces Americas AE - Armed Forces Europe AP - Armed Forces Pacific American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands
Zip		12345 or 12345-6789
Accounts Payable Contact Name
Accounts Payable Phone Number		Phone number is in an invalid format.
Accounts Payable Fax
Accounts Payable E-Mail Address		email@domain.com ( or .net, .org, etc. )

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Names And Titles Of Officers

Name and Title of Owners or Officers (enter one per line)

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Agreement

Credit will be extended based on the business’ commercial credit score.

All accounts are due and payable not more than 30 days from their respective invoice dates unless otherwise negotiated. The seller reserves the right to apply an interest rate of 1.5% per month (18% annually) to any unpaid amounts from and after the 30th day following their respective invoice dates. Should it be necessary to engage others to collect past due moneys from the undersigned or the company, the seller shall be entitled to all costs, including collections fees, attorney’s fees, court costs, and any other reasonable expenses, both at trial and upon appeal.

Initials Of Corporate Officer		* Initials are required
Title
Date

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