Credit Application

  • Credit Check Application

    Please fill out the online form below. A customer service representative will contact you directly to follow up.
  • Please provide (Name) (Address) (Acct #) (contact) Has the firm or any of its principals ever been Bankrupt? Yes No I f Yes, explain
  • Disclaimer

    Any misrepresentation in this application will be considered evidence of fraud, since this information is the basis for the credit check. The undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references and principals listed. In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed and agrees to pay a service charge per month of 11/2% per month (18% annual percentage rate) on all past due balances. In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees, whether or not litigation has commenced, and all costs of litigation incurred. The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.

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