Credit Application

GENERAL INFOCompany Name *
Contact person *
Bill to Address *
City *
State *
Zip Code *
Type of business *
Year business opened 
Federal ID# or SS# 
Principals name 
Website 
Credit line requested 
Annual sales 
Number of employees 
Commercial space occupied 
How did you hear about ASD 
Branch Address *
City *
State *
Zip Code *
Branch Phone *
Email *
Fax 
ACCOUNTS PAYABLEContact person *
Email *
Phone *
Fax 
PURCHASESContact person *
Email *
Phone *
Fax 
Please, attach a file with references or fill out the table below, minimum of 3 references is required
Attach a File with References 

REFERENCES:

Bank Reference (references will be verified)Bank Name *
Account # *
Address *
Contact Person *
Phone *
Date account opened *

Trade Reference (references will be verified)

Company Name *
Contact Person *
Address *
Phone *
Fax 
Email *

Trade Reference (references will be verified)Company Name *
Contact Person *
Address *
Phone *
Fax 
Email *

Trade Reference (references will be verified)Company Name *
Contact Person *
Address *
Phone *
Fax 
Email *

Company *

Print your name *

Attach W9 *

Attach resale certificate *

The undersigned herby agrees that should a credit account be opened, and in the event of default in the payment of any amount due, and if such account is submitted to a collection authority, to pay an additional charge equal to the cost of collection including court costs. The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

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