Business credit application

Business information:

Business name
Corporate entity (if business is owned by another entity)

Tax ID/EIN #
Type of business:
Years in operation:
State of registry
State of operation
Entity typeSole ProprietorshipPartnershipLimited Liability Company (LLC)CorporationOther

Business Address:

Street:
City:
State:
Zip code:

CFO/Financial officer:

Name:
Account payable email:
Email:
Phone:

Checking bank account:

Bank name:
Checking account number:
Bank phone:

Savings bank account:

Bank name:
Savings account number:
Bank phone:

Credit/loan bank account:

Bank name:
Credit/loan account number:
Bank phone:

Trade reference #1:

Business name:
Contact name:
Business address:
Bank phone:
Account age (in years):
Credit limit:
Current balance:

Trade reference #2:

Business name:
Contact name:
Business address:
Bank phone:
Account age (in years):
Credit limit:
Current balance:

Trade reference #3:

Business name:
Contact name:
Business address:
Bank phone:
Account age (in years):
Credit limit:
Current balance:

Credit request:

Amount of credit:
Annual net income:
Total business assets:
Total business liabilities:
Have any officers filed a bankruptcy petition?YesNo
Is your company subject to any litigation?NoYes
If yes, please explain.

Ready to submit

By entering my name below, I certify that the information provided in this credit application is true and accurate, and I consent to a credit report request.

Applicant's full name:
Applicant's signature:
Date:

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