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.

OPEN ACCOUNT CREDIT APPLICATION

Business Name: _____________________________________________________

Billing Address: _____________________________________________________

_____________________________________________________

Shipping Address: _____________________________________________________

_____________________________________________________

Phone: _____________________ Fax: ________________________

Name of Parent Co. ( If Subsidiary ): ___________________________________

Type of Business: ( ) Individual ( ) Partnership ( ) Corporation

Number of Years in Business: ______

Federal Tax Number: __________________

Social Security Number: _________________

PROPRIETOR, PARTNERS OR OFFICERS

Name: _________________________________ Title: ______________________

Home Address: _____________________________________________________

Phone: ___________________________

Name: _________________________________ Title: ______________________

Home Address: _____________________________________________________

BANK REFERENCE

Name: _________________________________ Account Number: __________________

Address: ___________________________________ Phone: ______________________

TRADE REFERENCES

Name: _________________________________ Phone: __________________

Address: ___________________________________ Contact : ______________________

Name: _________________________________ Phone: __________________

Address: ___________________________________ Contact : ______________________

INDIVIDUAL RESPONSIBLE FOR PAYMENT OF ACCOUNT

Name: _________________________________ Title: ______________________

The above information is for the purpose of obtaining credit and is warranted to be true.

I/We hereby authorize the firm to whom the application is made to investigate the references listed pertaining to my/our credit and financial responsibility.

Business Name: _____________________________________________

Authorized 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.