APPLICATION FOR CREDIT
Company Information:
Name of Company or Individual requesting credit:
Company or Individual Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail:
E-mail
Phone Number:
-
Area Code
Phone Number
Fax Number:
-
Area Code
Phone Number
Billing Address and Accounting Contacts:
Name of Company (if different from above):
Company Name
Name of Contact Person (Accounts Payable):
Company Name
Billing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail:
E-mail
Phone Number:
-
Area Code
Phone Number
Fax Number:
-
Area Code
Phone Number
Ownership:
Business Type:
Corporation
Partnership
Individual
Name of Principal #1:
Individual Name
Address of Principal #1:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail of Principal #1:
E-mail
Phone Number of Principal #1:
-
Area Code
Phone Number
Fax Number of Principal #1:
-
Area Code
Phone Number
Name of Principal #2 (if applicable):
Individual Name
Address of Principal #2 (if applicable):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail of Principal #2 (if applicable):
E-mail
Phone Number of Principal #2 (if applicable):
-
Area Code
Phone Number
Fax Number of Principal #2 (if applicable):
-
Area Code
Phone Number
Bank/Finance References:
Bank Name:
Bank Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Phone Number:
-
Area Code
Phone Number
Bank Fax Number:
-
Area Code
Phone Number
Branch Manager Name (or other Bank Contact, please list Name and Title):
Bank Contant Name and Title
Trade References:
Please provide 3 Trade References
Name of Trade Reference #1:
Business Name
Address of Trade Reference #1:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail of Trade Reference #1:
E-mail
Phone Number of Trade Reference #1:
-
Area Code
Phone Number
Name of Trade Reference #2:
Business Name
Fax Number of Trade Reference #1:
-
Area Code
Phone Number
Address of Trade Reference #2:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail of Trade Reference #2:
E-mail
Phone Number of Trade Reference #2:
-
Area Code
Phone Number
Fax Number of Trade Reference #2:
-
Area Code
Phone Number
Name of Trade Reference #3:
Business Name
Address of Trade Reference #3:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail of Trade Reference #3:
E-mail
Phone Number of Trade Reference #3:
-
Area Code
Phone Number
Fax Number of Trade Reference #3:
-
Area Code
Phone Number
Application Signature:
By entering your Name, Title and Date below you certify that all information on this form is correct. You also certify that you fully understand our credit terms and agree to the proper payment in consideration of extended credit. You further agree that cash sales will be acceptable until acknowledgement of credit approval from Tri-County Packaging is received.
Signature:
Name of Individual completing this Application for Credit
Title:
Title of Individual completing this Application for Credit
Date:
Today's date
Submit
Should be Empty: