NEW CLIENT – CREDIT APPLICATION

Date:

Company Name:

Company Telephone:

Date Established:

Company Officers (name and title):

Bank Reference

Bank Name:

Bank Address:

Account #:

Bank contact name, phone number and email:

Trade References

Name:

Contact:

Telephone:

Email:

Name:

Contact:

Telephone:

Email:

Name:

Contact:

Telephone:

Email:

Authorized Signature:

Title:

*Credit terms, net 30 from invoice date, upon credit approval