Commercial Credit Application

01

Business information

Tell us about your company. Use your legal registered name.

Legal business name *

DBA / trade name

Entity type *

Federal Tax ID (EIN) * Format: 12-3456789

State of incorporation *

Years in business *

Number of employees *

Website

D-U-N-S number Optional · 9 digits

02

Billing & service addresses

Where invoices and service should be directed.

Billing street address *

City *

State / Province *

Postal code *

Country *

Service address is the same as billing

Service street address

City

State / Province

Postal code

03

Accounts payable contact

Primary contact for invoices and statements.

Full name *

Title

Email *

Phone *

Invoice delivery *

A purchase order number is required on every invoice

Our organization is sales-tax exempt

04

Credit request

Tell us how much credit your business needs and your preferred terms.

Requested credit limit (USD) *

Preferred payment terms *

05

Bank reference

Primary depository institution. We never request full account numbers.

Bank name *

Bank phone *

Account contact

Account last 4 digits * For verification only — never the full number

06

Trade references

Provide three suppliers with whom you currently hold an open account.

Reference 1

Company *

Contact name

Phone *

Email

Account number

Reference 2

Company *

Contact name

Phone *

Email

Account number

Reference 3

Company *

Contact name

Phone *

Email

Account number

07

Authorization & signature

An authorized officer must certify and sign this application.

Authorized signer name *

Title *

Email *

Electronic signature *

I certify that the information provided is true, complete, and accurate to the best of my knowledge. *

I authorize the credit references, bank, and credit bureau data provided in this application to be investigated. *

I have read and agree to the standard Terms of Sale, including finance charges on past-due balances. *

(Optional) As an individual, I personally guarantee payment of amounts owed by the applicant.

Additional notes

Questions?

(877) 322-3437

Open a trade credit account

Business information

Billing & service addresses

Accounts payable contact

Credit request

Bank reference

Trade references

Authorization & signature