[Company Name]

CREDIT APPLICATION FOR A BUSINESS ACCOUNT

BUSINESS CONTACT INFORMATION

Title	Date business commenced
Company name	Sole proprietorship
Phone | Fax	Partnership
E-mail	Corporation
Registered company address City, State ZIP Code	Other

BUSINESS AND CREDIT INFORMATION

City, State ZIP Code	Bank name:
How long at current address?	Primary business address City, State ZIP Code
Phone	Phone
Fax	Account number
E-mail	Type of account	Savings Checking Other

BUSINESS/TRADE REFERENCES

Company name	Phone
Address	Fax
City, State ZIP Code	E-mail
Type of account	Other
Company name	Phone
Address	Fax
City, State ZIP Code	E-mail
Type of account	Other
Company name	Phone
Address	Fax
City, State ZIP Code	E-mail
Type of account	Savings Checking Other	Other

agreement

All invoices are to be paid 30 days from the date of the invoice.

Claims arising from invoices must be made within seven working days.

By submitting this application, you authorize [Company Name] to make inquiries into the banking and business/trade references that you have supplied.

SIGNATURES

Signature	Signature
Name and Title	Name and Title
Date	Date