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CREDIT APPLICATION

LEGAL NAME OF COMPANY

COMPANY DBA (IF APPLICABLE)

D&B#

COMPANY BUSINESS ADDRESS

BILLING ADDRESS (IF DIFFRENT FROM BUISNESS ADDRESS)

MAIN PHONE NUMBER

FAX NUMBER

YEAR ESTABLISHED

COMPANY INFORMATION

CORP

SOLE PROPRIETORSHIP

PARTNERSHIP

LLC

PLEASE SELECT WHICH APPLIES

THE OWNERS OR PRIMARY STOCKHOLDERS ARE :

OWNER 1 - NAME

TITLE

Email

Phone

OWNER 2 - NAME

TITLE

Email

Phone

OWNER 3 - NAME

TITLE

Email

Phone

ACCOUNTS PAYABLE CONTACT

ACCOUNTS PAYABLE EMAIL

AMOUNT OF CREDIT LINE REQUESTED

IS THERE ANY ORDER PENDING

YES

NO

ORDER AMOUNT

ESTIMATED MONTHLY PURCHASES :

1ST YEAR

2ND YEAR

FOR CREDIT LINE REQUESTS > $25,000, FINANCIAL STATEMENT MAY BE REQUIRED !

FINANCIAL STATEMENT ARE ATTACHED :*

YES

NO

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