CREDIT APPLICATION AND AGREEMENTCredit Application and Agreement • July 19th, 2021
Contract Type FiledJuly 19th, 2021APPLICANT INFORMATION APPLICANT NAME (S) (Person/Business applying for Credit) TRADE NAME (If Applicable, DBA Name) YEARS INBUSINESS POSTAL ADDRESS STREET ADDRESS E-MAIL ADDRESS AREA CODE - TELEPHONE # CITY COUNTY STATE ZIP CODE AREA CODE - FAX # SHIPPING ADDRESS, CITY, STATE, ZIP (IF DIFFERENT FROM ABOVE) BILLING ADDRESS, CITY, STATE, ZIP (IF DIFFERENT FROM ABOVE) TYPE OF BUSINESS STRUCTURE (CHECK ONE): PARTNERSHIP CORPORATION SOLE PROPRIETOR OTHER – INDICATE: LLC (Limited Liability Company) LLP (Limited Liability Partnership) STATE OF ORGANIZATION STATE ORGANIZATION NUMBER FEDERAL TAX ID NO. In the following boxes, provide an email address or addresses for electronic delivery of invoices and account statements. E-MAIL ADDRESS (Max. 40 characters) E-MAIL ADDRESS (Max. 40 characters) E-MAIL ADDRESS (Max. 40 characters) E-MAIL ADDRESS (Max. 40 characters) LENDER / BANK REFERENCES LENDER / BANK NAME CONTACT NAME AREA CODE - FAX NO AREA CODE - TELEPHONE NO ADDRESS CITY STATE ZIP COD