Complete a Credit Application Form

If you prefer you can download the Microsoft Word or PDF version for submission.

Your submittal of this application implies your acknowledgment and acceptance of the BCD Terms and Conditions shown at the bottom of this form.

Business Trade Name*

Business Legal Name*

Business Phone*

Business Fax*

Billing Address*

Suite, Unit #

City*

State/Province/Region*

Zip/Postal Code*

Country*

Length of time operating the above named business (years):*

Length of time under current ownership (years):*

Length of time at the above address (years):*

Number of Employees*

Type of legal entity (check one):*

Corporation
Partnership
Sole Proprietorship
LLC
LLP
Other

If "other" please specify:

D & B #*

Federal Tax ID# (TIN)*

Subsidiary of (Company name, city, state/province, zip/postal code):

Affiliated Business(es):

Officers/Owners Information

Name/Title 1*

% Ownership*

Address*

Name/Title 2

% Ownership

Address

Name/Title 3

% Ownership

Address

Annual Sales Income (USD)*

Anticipated Yearly Volume (USD)

Credit Line Desired (USD)*

*For credit amounts greater than $150,000, the applicant MUST submit audited or reviewed financial statements not older than 12 months from the financial year-end, along with this application.

Approximate Amount of Initial Order (USD)

Accounts Payable Information

(who to email invoices/question past due invoices)

Accounts Payable Contact*

Accounts Payable Email*

Please use your company email address. We may not accept requests that use Google, Yahoo, Hotmail, etc.

Accounts Payable Phone #*

Upload Financial Documents*

Drop files here or

Max. file size: 128 MB.

Sales Tax Information (U.S. Customers Only)

Are you sales tax exempt?*

Yes
No

(If YES, please provide any state-issued sales tax exemption certificates for the states to which BCD will be shipping)

Please attach ALL tax exempt certificates [jpg, png, or pdf (version 7 or later)]*

Drop files here or

Max. file size: 128 MB.

Banking Information

Bank Name*

Bank Address*

Suite, Unit #

City*

State/Province/Region*

Zip/Postal Code*

Country*

Checking Account #*

Savings Account #*

Loan #*

Account Officer*

Account Officer Phone #*

Account Officer Fax #

Account Officer Email*

Please use your company email address. We may not accept requests that use Google, Yahoo, Hotmail, etc.

Credit References

Creditor 1*

Contact*

Phone*

Email Address*

Please use a company email address. We may not accept requests that use Google, Yahoo, Hotmail, etc.

Acct #*

Creditor 2*

Contact*

Phone*

Email Address*

Acct #*

Creditor 3*

Contact*

Phone*

Email Address*

Acct #*

Creditor 4*

Contact*

Phone*

Email Address*

Acct #*

Terms and Conditions

1. The undersigned Applicant agrees to the use of its signature on this application as authorization to release credit information from Applicant’s bank and from all other sources of credit information regarding the Applicant.
2. Should credit availability be granted by BCD to Applicant, all decisions with respect to the extension or continuation of this credit shall be at the sole discretion of BCD.
3. When requested, the undersigned Applicant agrees to provide annual financial information to properly substantiate the continuation of credit extension as required by BCD.
4. The undersigned Applicant hereby agrees that all amounts due for goods and services purchased from BCD are subject to Net 30 invoice terms unless otherwise specified in writing by BCD.
5. No term or condition contained in any purchase order or other communication to BCD shall be valid and binding unless agreed to in writing by an authorized representative of BCD or is identical to BCD’s written terms and conditions of sale.
6. The undersigned Applicant acknowledges that in the event of default, including payment default (defined as payment received beyond terms as designated on BCD invoices), BCD reserves the right to take any or all of the following actions: a. Impose a moratorium on order shipment, b. Reduce the credit limit, c. Conduct a new credit investigation requiring updated trade and bank reference information, d. Require financial statements to clarify the customer’s financial status, e. Require immediate payment of the account balance in full, f. Revoke open account terms.
7. The undersigned Applicant agrees to notify the BCD Credit Department of any changes of ownership and further agrees to remain liable for all purchases made prior ro such change unless BCD otherwise agrees in writing.
8. The undersigned Applicant agrees that any disputes arising out of this agreement or goods and merchandise ordered or delivered pursuant hereto will be governed and settled under applicable principles of Illinois law, under jurisdiction of the State of Illinois Courts and that venue in any such action shall be in the County of Lake in Illinois.
9. The Applicant hereby certifies the accuracy and truthfulness of the information provided in this application, and in the information provided in addition to this application, and acknowledges the such information is provided for the purpose of obtaining or maintaining credit with BCD. The undersigned represents and warrants that the information provided is true and complete and that it may be considered as continuing to be true and correct until a written notice of change is provided to BCD by the undersigned. By signing this application the signatory affirms that (s)he is a duly authorized representative of the Applicant company, with full power and authority to agree to the terms and conditions set forth in this application and to bind the Applicant hereto.
10. I affirm that the information contained in this application is complete and accurate. All information contained in this application is material and any omission and/or misrepresentation could result in immediate termination of credit extended by BCD.

By signing this application, I acknowledge that I have read and understand the terms and conditions of sale and agree to abide by them.

Signature*

Title*

Company represented*

Date*
MM slash DD slash YYYY

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