Fillable Printable Blank Credit Check Application Form
Fillable Printable Blank Credit Check Application Form
Blank Credit Check Application Form
Credit Check Application
Business Name_____________________________________________________________________
Phone (_____) _______________________________ Fax (____)____________________________
Address____________ _________________________ _________For Past_________ ____years
Billing Address__________ __________________________ __________________________ ___
D/B/A_____________________________Fede ral Tax ID#______ ____________ _____________
Former Busin ess Address (if applicable)___________ _______________ _______________ ____
Type of Business______________Date Established_____________ How long in Business__________
Mortgage Hol der/Landlord____ __________________________ _________________________ _
Address____________ _________________________ _____ Phone #_________________ ____
Does State, County, or City require a License? Yes NoIf Yes, License#______________ ___
OWNERSHIP: Sole Proprietorship Partnership Corporation
PRINCIPAL: ________________________________________________________________
(NAME) (Title) (SS#)
PRINCIPAL: ________________________________________________________________
(NAME) (Title) (SS#)
PRINCIPAL: __________________________________________________________ ______
(NAME) (Title) (SS#)
PRINCIPAL: __________________________________________________________ ______
(NAME) (Title) (SS#)
Authorized P ersonnel ______________________ _________________________ ____________
TRADE REFERENCES
NAME ADDRESS/TELEPHONE #
_________________________________ ___________________________________
______________________ _________ ___________________________________
_________________________________ ______________________ ____________
BANK REFERENCES
_____________________________________________________________________________
(Name) (Address) (Acct #) (contact)
_____________________________________________________________________________
(Name) (Address) (Acct #) (contact)
_____________________________________________________________________________
(Name) (Address) (Acct #) (contact)
Has the firm or any of its princ ipals ever been Bankrupt? Yes No
If Ye s , ex p la i n _________________________________________________________________________
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
ag re ed and agrees to pay a service charge per month of I-1/2% 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
authori ty to execute this credi t ag reement on be half of the business identi fied.
__________________________________________________________
(Name of Business)
___________________________________________________________________________
(Print Name) (Title) (Signature)
___________________________________________________________________________
(Print Name) (Title) (Signature)
Credit Limit________________ _____
