CREDIT APPLICATION
Date ________________
Name of Business: ________________________________________________________
Shipping Address: ________________________________________________________
___ commercial ___ residential
City/State/Zip ____________________________________________________________
Telephone No: (_____) _________________ Fax No: (_____) ____________________
Email: ________________________________ Website: __________________________
Requested Credit Line: _____________________ Payment Terms: _________________
If mailing address for invoices and telephone number at that address are different from above. Please complete the following:
Company Name: _________________________________________________________
Mailing Address: _________________________________________________________
City/State/Zip: ___________________________________________________________
Telephone No: (_____) __________________ Fax No: (_____) ____________________
Is this business a: ___ Corporation ___Partnership ___Proprietorship ___LLC
If corporation what state: ___________________ how long has business been established under current ownership? YearÕs _____ OwnerÕs Social Security # __________________
If this business is a division or subsidiary of another business, please provide the information below:
Name of Parent Company: __________________________________________________
Address: ________________________________________________________________
City/State/Zip: ___________________________________________________________
List below the name(s) and resident address(es) of the proprietorship(s), or participant(s), or officer(s) of the business:
Name: ______________________________________ Title: ____________________
Address: ____________________________________ Phone: ___________________
City/State/Zip: _______________________________ Email: ___________________
Name: _____________________________________ Title: _____________________
Address: ___________________________________ Phone: ____________________
City/State/Zip: ______________________________ Email: ____________________
Financial Institutions:
Bank: ______________________________________ Account No: ______________
Address: ____________________________________ Bank Officer: _____________
City/State/Zip: _______________________________ Phone: ___________________
Fax: ___________________________
Bank: ______________________________________ Account No: _______________
Address: ____________________________________ Bank Officer: ______________
City/State/Zip: _______________________________ Phone: ___________________
Fax: ____________________________
Is there a borrowing relationship with either of the above institutions? ___yes ___no
Trade References
Company:
___________________________________ Account No: ________________
Address:
____________________________________ Phone: _____________________
City/State/Zip: ___________________________________________________________
Contact Name:
_______________________________ Fax: _______________________
Company:
___________________________________ Account No: ________________
Address:
____________________________________ Phone: _____________________
City/State/Zip:
___________________________________________________________
Contact Name:
_______________________________ Fax: _______________________
Company:
___________________________________ Account No: ________________
Address: ____________________________________
Phone: _____________________
City/State/Zip:
___________________________________________________________
Contact Name:
_______________________________ Fax: _______________________
Contact Name:
_______________________________ Fax: _______________________
Who is authorizes to issue
payments and issue checks?
___________________________
________________________________________________________________________
Who is authorized to issue
Purchase orders?
___________________________________
For value received, and in
consideration of any extension of credit from Clearly Fun Sop, Inc. The undersigned hereby guarantees
prompt payment when due.
Clearly Fun Soap, Inc. Is authorized to obtain credit
information from any banking institution or vendor listed on this credit
application.
EXECUTED THIS ____ DAY OF
_________________. 20____.
Signature:
________________________________________________________________
Printed or Typed Name:
_____________________________________________________
Capacity of Office:
_________________________________________________________
Witness:
_________________________________________________________________
Please include a copy of
the Retail Merchant Certificate from your state with your completed credit
application.