Dealer Credit Application

Fill in the credit application below or CLICK HERE to download the application.

Company Name*
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Parent Company (if any)
Years in business
Number of employees
Business License No.
Sales Tax No.
Type of ownership
Email
Website
Trade Organization Memberships
Buyer's Name*
Buyer's Phone*
Buyer's Email*
Additional Contact Information
A/P Contact Name. Email & Phone #
Owner/Officer 1 Information
Name
Title
Phone
Address
Street Address Address Line 2 City State ZIP Code
Owner/Officer 2 Information
Name
Title
Phone
Address
Street Address Address Line 2 City State ZIP Code
Major Supplier 1
Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Account Number
Major Supplier 2
Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Account Number
Major Supplier 3
Name
Phone
Address
Street Address Address Line 2 City State ZIP Code
Account Number
Bank References
Bank 1 Name
Bank 1 Phone
Bank 1 Address
Street Address Address Line 2 City State ZIP Code
Bank 1 Account Type
- Checking
- Loan
Bank 2 Name
Bank 2 Phone
Bank 2 Address
Street Address Address Line 2 City State ZIP Code
Bank 2 Account Type
- Checking
- Loan
Credit Application Terms of Agreement
PLEASE READ AND CONSENT TO THE FOLLOWING STATEMENT AFTER YOU HAVE COMPLETED APPLICABLE SECTIONS*
I Agree
You are authorized to contact parties indicated on this application for verification. For purposes of obtaining credit, I/We certify that the information given in this application is true and accurate, and any financial information submitted correctly reflects our financial condition. I/We agree to pay all invoices within stated terms and to pay services charges on amounts paid after invoice due dates at a rate of 1.5% per month, or the maximum allowable rate, whichever is less. In event suit is instituted to collect amounts owing to you and a judgment is rendered in your favor, I/We agree to pay court costs and reasonable attorney fees. I/We have read this agreement and a copy has been made available to us or is available to us upon our requesting same from the credit department.
PERSONAL GUARANTEE – PLEASE DO NOT INCLUDE TITLE WHEN SIGNING PERSONAL GUARANTEE*
I Agree
For value received, including merchandise, services, or other valuable consideration, I hereby unconditionally guarantee at all times, full and prompt payment, upon demand, of any indebtedness which has been incurred under this agreement. I understand this to mean that I will personally guarantee payment of all debts and obligations under this agreement.

Dealer Credit Application

Owner/Officer 1 Information

Owner/Officer 2 Information

Major Supplier 1

Major Supplier 2

Major Supplier 3

Bank References

Credit Application Terms of Agreement