CREDIT APPLICATION – ACCOUNT AGREEMENTCredit Application – Account Agreement • November 20th, 2015 • Utah
THIS APPLICATION IS VALID ONLY IF SIGNED BY OWNER/PARTNER/CORPORATE OFFICER ON REVERSE SIDE COMPANY NAME: PHONE #: ADDRESS: FAX#: MOBILE#: BILLING ADDRESS: A/P CONTACT: REQUESTED CREDIT LIMIT: A/P PHONE: A/P E-MAIL ADDRESS: OWNERSHIP: PROPRIETORSHIP PARTNERSHIP LLC CORPORATION—STATE DATE: DATE BUSINESS WAS STARTED: TYPE OF BUSINESS: FEDERAL ID#: DO YOU REQUIRE A PURCHASE ORDER: CONTRACTOR’S LICENSE #: SALES TAX EXEMPT? : NUMBER OF EMPLOYEES: RESALE #: WEBSITE: E-MAIL ADDRESS: OWNERS/PARTNERS/CORPORATE OFFICERS: NAME/TITLE: HOME PHONE #: SOCIAL SECURITY #: HOME ADDRESS: DATE OF BIRTH: 1. 2. 3. BANK REFERENCE: NAME: CHECKING ACCOUNT #: ADDRESS: LOAN ACCOUNT #: PHONE #: CONTACT NAME: FAX #: TRADE REFERENCES: 1. NAME: ACCOUNT #: ADDRESS: PHONE#: FAX #: 2. NAME: ACCOUNT #: ADDRESS: PHONE#: FAX #: 3. NAME: ACCOUNT #: ADDRESS: PHONE#: FAX #: