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Business Address*

Company Principals Responsible For Business Transactions

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Address

References

Name of Contact
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(1) Trade References

Contact Name

(2) Trade References

Contact Name
Accounts not paid within 30 days of invoice date will be in default and a late payment charge computed by a “periodic rate” of 1 ½ % per month will be added. Buyer agrees to any reasonable attorney or collection fees incurred by Seller in securing payment. CONFIRMATION OF INFORMATION ACCURACY AND RELEASE OF AUTHORITY TO VERIFY I hereby certify that the information in this credit application is correct. The information included in this credit application is to be used to determine the amount and conditions of credit to be extended. I understand that the other sources of credit considered necessary in making the determination may also be used. Further, I hereby authorize the bank and trade references listed in this credit application to release the information necessary to assist in establishing a line of credit.
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