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Quotation Request
Credit Application

 

Company Name:

Street Address:


Mailing Address:


Phone:

Fax:

E-mail:

Type of Business:

Federal ID:

Purchase Orders Required:Yes No

Credit terms granted to customers:

Check one: Proprietorship Partnership Corporation

Date Incorporated:

Charter No:

Officers:

President:

Vice-President:

Sec./Treasurer

Check one: Branch Division Subsidiary None

Bank
Information:

Bank Name:

Address:

Phone:

Account Type:

Credit References - please include name, address and phone number (no service, utility, phone or office supply companies):

1.

2.

3.

4.

The foregoing information has been carefully read by the undersigned and is to my knowledge in all respects complete, accurate and truthful. It is presented for your consideration in the extension of credit privileges to the above named entity. Authorization is hereby given to obtain credit information from the above listed references and any and all credit agencies. Upon approval and granting credit, the above entity agrees to pay uncontested billings remaining unpaid beyond terms granted/billed upon demand, plus finance charges at the maximum legal rate in the state of Texas, plus any collection, attorney fee and court costs incurred in the collection of delinquent accounts.

Officer's Name:

 

 

 

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