Commercial Credit App

Commercial/Industrial Credit Application

Please fill out all fields. Please be sure to read the purchase agreement below before submitting this application.


About Your Business:

Corporate Name (Buyer):


Trade Name:

Billing Address:
(City, State, ZIP)


Work Phone:

Fax:

Federal ID #:

Dun & Bradstreet (D&B) #:

Email:

Years in Business:


Owner's Information:

Name:

Title:

Address:
(City, State, ZIP)


 
Name:

Title:

Address:
(City, State, ZIP)


 

Registered Agent:

Name:

Phone #:

Address:
(City, State, Zip)



Bank References:

Bank Name:

Account Type:

Account #:

Contact:

Phone:

Bank Address:
(City, State, ZIP)



Bank Name:

Account Type:

Account #:

Contact:

Phone:

Bank Address:
(City, State, ZIP)



Trade References:

Name:

Mailing Address:
(City, State, ZIP)


Phone:

Fax:


Name:

Mailing Address:
(City, State, ZIP)


Phone:

Fax:

Name:

Mailing Address:
(City, State, ZIP)


Phone:

Fax:


Name:

Mailing Address:
(City, State, ZIP)


Phone:

Fax:


Current Fuel Supplier:


Company:


Purchase Agreement:



Guarantor: Date:
Guarantor: Date:
Guarantor: Date:
Current Payment Terms: Net thirty (30) days from date of delivery upon approved credit.
Customer: Date:

Please check the box to verify



 

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