SlideShare a Scribd company logo
Insert Legal Name & Logo Here
NON-DEALER CREDIT APPLICATION
Company Name ____________________________________________ ID# (i.e. FID# in the US)_______________
Product Line Type (being applied for): ________________________________________________________
Street __________________________

Phone # (____)_____________ Fax # (____)_______________

City __________________________

State/Providence ___________

Corporation [

]

LLC [

]

Partnership [

]

Zip ______________
Proprietorship [

]

BANK REFERENCE
Bank ___________________________________________ Branch ________________________________
Address ________________________Telephone (_____)________________Fax (____) _________________
Contact _______________ Email _______________________________ Checking [ ] Loan [ ] Savings [ ]
Bank ___________________________________________ Branch ________________________________
Address ________________________Telephone (_____)________________ Fax (_____) _____________
Contact _______________ Email _______________________________ Checking [ ] Loan [ ] Savings [ ]
TRADE REFERENCE
Name

City & State/
Providence

Contact

Email

Fax #

Telephone

________________________________________________________(_____)___________(_____)______________
________________________________________________________(_____)___________(_____)______________
________________________________________________________(_____)___________(_____)______________
________________________________________________________(_____)___________(_____)______________
________________________________________________________(_____)___________(_____)______________
________________________________________________________(_____)___________(_____)______________
I authorize the above bank and business references to give any and all necessary information to you which will assist
you in your credit inquiry. I release any claim I have for breach of contract or invasion of privacy because of
information furnished. This application is given for the purpose of obtaining credit. In the event of any material
change in our financial condition, we will notify you immediately in writing.
Name (print) ______________________________
Date ______________________________
PLEASE RETURN TO: ATTN: CREDIT CONTACT
LEGAL NAME
MAILING ADDRESS

Signature _________________________________
Title ____________________________________

Ph. Fax E-mail

Rev7/13
Contact Information
Accounts Payable Contact ___________________ Email Address ______________________
Phone (

) ________________________ Mobile (

) _____________________________

All of our documents are emailed rather than mailed. Identify what name/email addresses you would like
these specific documents to go to (there can be more than one for each)
Name

Email

1. Warranty Credit Memos: ____________________________________________________
2. Credit Memos: ____________________________________________________________
3. Invoices: _________________________________________________________________
4. Customer Statements:_______________________________________________________
5. Sales Order Confirmations: __________________________________________________
6. Accounts Payable Contact: __________________________________________________
PRINCIPAL OWNERS
FIRST, MI,
LAST NAME

TITLE

CITY / STATE or Prov

SS #

% OWN

SPOUSE
NAME

____________________ __________ _______________ ___________ ______ ___________
____________________ __________ _______________ ___________ ______ ___________
____________________ __________ _______________ ___________ ______ ___________
____________________ __________ _______________ ___________ ______ ___________

Rev7/13

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Non dealer credit application template

  • 1. Insert Legal Name & Logo Here NON-DEALER CREDIT APPLICATION Company Name ____________________________________________ ID# (i.e. FID# in the US)_______________ Product Line Type (being applied for): ________________________________________________________ Street __________________________ Phone # (____)_____________ Fax # (____)_______________ City __________________________ State/Providence ___________ Corporation [ ] LLC [ ] Partnership [ ] Zip ______________ Proprietorship [ ] BANK REFERENCE Bank ___________________________________________ Branch ________________________________ Address ________________________Telephone (_____)________________Fax (____) _________________ Contact _______________ Email _______________________________ Checking [ ] Loan [ ] Savings [ ] Bank ___________________________________________ Branch ________________________________ Address ________________________Telephone (_____)________________ Fax (_____) _____________ Contact _______________ Email _______________________________ Checking [ ] Loan [ ] Savings [ ] TRADE REFERENCE Name City & State/ Providence Contact Email Fax # Telephone ________________________________________________________(_____)___________(_____)______________ ________________________________________________________(_____)___________(_____)______________ ________________________________________________________(_____)___________(_____)______________ ________________________________________________________(_____)___________(_____)______________ ________________________________________________________(_____)___________(_____)______________ ________________________________________________________(_____)___________(_____)______________ I authorize the above bank and business references to give any and all necessary information to you which will assist you in your credit inquiry. I release any claim I have for breach of contract or invasion of privacy because of information furnished. This application is given for the purpose of obtaining credit. In the event of any material change in our financial condition, we will notify you immediately in writing. Name (print) ______________________________ Date ______________________________ PLEASE RETURN TO: ATTN: CREDIT CONTACT LEGAL NAME MAILING ADDRESS Signature _________________________________ Title ____________________________________ Ph. Fax E-mail Rev7/13
  • 2. Contact Information Accounts Payable Contact ___________________ Email Address ______________________ Phone ( ) ________________________ Mobile ( ) _____________________________ All of our documents are emailed rather than mailed. Identify what name/email addresses you would like these specific documents to go to (there can be more than one for each) Name Email 1. Warranty Credit Memos: ____________________________________________________ 2. Credit Memos: ____________________________________________________________ 3. Invoices: _________________________________________________________________ 4. Customer Statements:_______________________________________________________ 5. Sales Order Confirmations: __________________________________________________ 6. Accounts Payable Contact: __________________________________________________ PRINCIPAL OWNERS FIRST, MI, LAST NAME TITLE CITY / STATE or Prov SS # % OWN SPOUSE NAME ____________________ __________ _______________ ___________ ______ ___________ ____________________ __________ _______________ ___________ ______ ___________ ____________________ __________ _______________ ___________ ______ ___________ ____________________ __________ _______________ ___________ ______ ___________ Rev7/13