Credit Application

Credit Application

NET 30 TERMS - Your submittal of this application implies your acknowledgement and acceptance of the Net 30 invoice terms.
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:*
Length of time at the above address:*
Number of Employees*
Annual Sales Income*
Reseller
- Yes
- No
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 #
Sales Tax Information
If no tax, please attach tax exempt certificate.
D & B #
Federal Tax ID# (TIN)
Attach tax exempt certificate
Drop files here or
Accounts Payable Information
(who to email invoices/question past due invoices)
Accounts Payable Contact*
Accounts Payable Email*
Accounts Payable Phone #*
Credit References
Credit Line Desired
Creditor 1*
Contact*
Phone*
Fax*
Email Address
Acct #*
Creditor 2*
Contact*
Phone*
Fax*
Email Address
Acct #*
Creditor 3*
Contact*
Phone*
Fax*
Email Address
Acct #*
Creditor 4*
Contact*
Phone*
Fax*
Email Address
Acct #*
Order Authorization
Select one of the following:
- We authorize BCD, Inc. to place orders only after receipt of our hard copy purchase orders.
- We authorize BCD, Inc. to place orders from signed quotes and we will pay for those orders as invoiced. The following signatures are acceptable:
This signature is acceptable.
This signature is also acceptable.
Conditions
Your submittal of this application implies your acknowledgement and acceptance of the Net 30 invoice terms.*
Signature
Release of Credit Information
The customer for the purpose of obtaining credit submits this information sheet to BCD, Inc. By signing this document the customer certifies that all information is correct to the best of the customer's knowledge. The customer hereby authorizes the release of credit and banking information to BCD, Inc. by the references listed on these pages. Must be signed by authorized person on bank account.*
Company represented*
Date*
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