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Credit Account Application Form
Credit Application Form
1
COMPANY ADDRESS & CONTACT INFORMATION
Legal Business Name:
DBA / Trade Name:
Street Address:
City:
State:
Zip/Postcode:
Primary Contact Name:
Title:
Telephone:
Mobile:
Email Address:
2
COMPANY DETAILS
Federal Tax ID #:
State Sales Tax ID #:
Total Projected annual turnover with AMS $
Amount of Credit Requested $:
Type of Business
Length of Time in Business:
Business Website or Social Media Page :
3
ACCOUNTS PAYABLE (A/P)
A/P Contact Name:
A/P Contact Phone:
A/P Contact Email Address:
Statement Email address if different from the above:
4
REGISTERED OFFICE
Registered Agent:
Street Address:
City:
State:
Zip/Postcode:
Company Registered Number:
Telephone:
Email:
5
BANKING INFORMATION
Bank Name:
Street Address:
City:
State:
Zip/Postcode:
Officer Contact Name:
Telephone:
Email:
Account Number:
Type of Account:
6
ALL PARTNERS, DIRECTORS, PROPRIETORS & OFFICERS
Person
1
Name:
Position:
Street Address:
City:
State:
Zip/Postcode:
Home Phone:
SSN:
Person
2
Name:
Position:
Street Address:
City:
State:
Zip/Postcode:
Home Phone:
SSN:
7
TRADE REFERENCES (All 3 references must be completed)
Reference
1
Company Name:
Account:
Contact Name:
Street Address:
City:
State:
Zip/Postcode:
Telephone:
Email:
Reference
2
Company Name:
Account:
Contact Name:
Street Address:
City:
State:
Zip/Postcode:
Telephone:
Email:
Reference
3
Company Name:
Account:
Contact Name:
Street Address:
City:
State:
Zip/Postcode:
Telephone:
Email:
After clicking submit, you will be taken to Docusign to digitally sign your document. When you have clicked, it can take up to 10 seconds for your form to be processed and transfer you to Docusign.
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