E.J. Sprague Co.

Credit Application

Credit Application
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BUSINESS INFORMATION
Legal (If different) :
Name of business :
Address :
City :
Type of business :
Tax Exemption Number (if applicable) :
State :
Zip :
Phone :
Fax :
Email :
 

DESCRIPTION OF BUSINESS
Number of Employees :
Credit Requested :
In Business Since :
Business Structure : Corporation Partnership Proprietorship Division/Subsidiary
 

COMPANY/PRINCIPALS RESPONSIBLE FOR BUSINESS TRANSACTIONS
Name Title Address Phone
 

BANK REFERENCES
Name of bank :
Branch :
Checking Account Number :
Name to contact :
Address :
Telephone Number :
 

TRADE REFERENCES
1. Firm Name 2. Firm Name 3. Firm Name
Contact Name Contact Name Contact Name
Telephone Number Telephone Number Telephone Number
Fax Number Fax Number Fax Number
Account open since Account open since Account open since
Address Address Address
 

CONFIRMATION OF INFORMATION ACCURACY AND RELEASE OF AUTHORITY TO VERIFY
I hereby certify that the information in this credit application is correct. The information included in this credit application is for use by the company in determining the amount and conditions of credit to be extended. I understand that the company may also contact other sources of credit information which it considers necessary in making this determination. Further, I hereby authorize the bank and trade references listed in this credit application to release the information necessary to assist the company in establishing a line of credit.
If you agree, type your full name here :
Title :
Today's Date :
POLICY STATEMENT: INITIAL ORDERS FROM NEW ACCOUNTS WILL NOT BE PROCESSED UNLESS ACCOMPANIED BY THE ABOVE REQUESTED INFORMATION.
TERMS: NET 30 DAYS FROM DATE OF INVOICE UNLESS OTHERWISE STATED.
( If the submit form button appears grayed out, this means you have submitted the form once. This is to protect you from multiple submissions. )


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