Warning:
These forms are provided AS IS.  They may not be any good.  Even if they are good in one state or jurisdiction, they may not work in another.  And the facts of your situation may make these forms inappropriate for you.  They are for informational purposes only, and you should consult an attorney before using them.

APPLICATION FOR OPEN ACCOUNT CREDIT

FOR STOCKING DEALERS

COMPANY NAME: _____________________________________________________

D/B/A: _____________________________________________________

BILLING ADDRESS: _____________________________________________________

_____________________________________________________

SHIPPING ADDRESS: _____________________________________________________

_____________________________________________________

PHONE NUMBER: ___________________________

FAX NUMBER: ______________________________

OWNER NAME: ___________________________

SALES TAX NUMBER: _______________________

BUYER: ____________________________________

STORE SIZE: ____________________________ SQ. FT.

BOOKKEEPER: ______________________________

NUMBER OF EMPLOYEES: ________________

NUMBER OF YEARS IN BUSINESS UNDER CURRENT OWNER: ___________

PURCHASE SUBJECT TO SALES TAX? [ ] YES [ ] NO

PURCHASE ORDERS REQUIRED? [ ] YES [ ] NO

LINE OF CREDIT REQUESTED: $____________________

TYPE OF COMPANY: [ ] SOLE PROPRIETORSHIP [ ] PRIVATE CORP.

[ ] PARTNERSHIP [ ] PUBLIC CORP.

[ ] OTHER ___________________________

TYPE OF BUSINESS: ___________________________

BANK BRANCH: __________________________________

BANK CONTACT: _________________________________

BANK ADDRESS: _________________________________

PHONE NUMBER: _________________________________

FAX NUMBER: ____________________________________

ACCOUNT NUMBER: ______________________________

TRADE REFERENCES (Please give complete addresses and account numbers):

COMPANY: ________________________________________

ADDRESS: _________________________________________

PHONE: _________________ FAX: __________________

ACCOUNT NUMBER: ________________________________

COMPANY: ________________________________________

ADDRESS: _________________________________________

PHONE: _________________ FAX: __________________

ACCOUNT NUMBER: ________________________________

COMPANY: ________________________________________

ADDRESS: _________________________________________

PHONE: _________________ FAX: __________________

ACCOUNT NUMBER: ________________________________

COMPANY: ________________________________________

ADDRESS: _________________________________________

PHONE: _________________ FAX: __________________

ACCOUNT NUMBER: ________________________________

To the best of my knowledge the above facts are represented as true. I am aware that falsification of any of this information may result in denial of credit by ___________________________________ Inc. My signature below indicates my permission for ___________________________________ Inc., to obtain credit information from the sources I have referenced, including any external credit reporting source, and any consumer credit agency. I understand that interest will be charged on all past due balances at a rate of ________% per month.

____________________________

Authorized By (Please Print)

_____________________________ ___________

Signature Date

Warning:
These forms are provided AS IS.  They may not be any good.  Even if they are good in one state or jurisdiction, they may not work in another.  And the facts of your situation may make these forms inappropriate for you.  They are for informational purposes only, and you should consult an attorney before using them.