when you are sure of the destination

CREDIT AGREEMENT AND APPLICATION

NAME OF CREDIT APPLICANT: *
E-MAIL: *
Street Address: *
City: *
State: *
Zip: *
Country: *
Phone: *
Billing address
Street Address: *
City: *
State: *
Zip: *
Country: *
Phone: *
Business information
Type of business: *
Nature of operation: *
IRS#: *
  Year established
*
At present location since
*
Dun & Bradstreet #
*
Annual sales: *
Terms of payment: *
Credit requested, $: *
List all owners, members, partners or ofices
Name *
Title *
Name 2
Title 2
Name 3
Title 3
REFERENCES (Provide names of companies from which you buy from on open account)
  Name * Phone * E-mail *
  Name Phone E-mail
  Name Phone E-mail
Bank name: *
Branch: *
Contact person name *
Anticipated number of shipment per month *
Payables contact person Name * Phone * E-mail *