Credit Application

Legal company Name

Business Type

Mailing Address

Street

City

County

State

Zip Code

Physical Address

Street

City

County

State

Zip Code

Phone

Fax

Federal TAX ID Number

Sales TAX Exempt

(If YES attach certificate Application)

Type of Business

Contractor Type

Business Start Date

Number of Employees

Business license / Registration

Open LIENS or Judgements

Accounts Payable Information

AP Contact

Phone

Fax

PO Num. Required

Yes No

Invoices by e-mail

Yes No

Primary e-mail

Secondary e-mail

Officers

President

Vice-president

Treasurer

Other Officer

Insurance Agent who handles bonding for buyer

Phone

Trade References

Business Name

Account Number

Phone

Fax

Business Name

Account Number

Phone

Fax

Business Name

Account Number

Phone

Fax

Mailing Address

Physical Address

Accounts Payable Information

Officers

Trade References

Roovi

20 Gleance Rd,Watford, London

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