Credit Limit Request





Contact Responsible for Purchasing

Principle Owners or Officers Information

Banking References

Trade References (at least three)






By signing below, I certify that I have the authority to bind the applying company to this agreement and that I agree to creditor’s terms of sale of NET 30. I also agree and accept that the credit limit and credit terms offered may be changed or withdrawn at the sole discretion of the creditor. Creditor shall include creditor subsidiaries, related companies and assigns.

The information given herein is offered as part of a request by the applicant for an extension of credit for commercial business use. The information provided is represented by the applicant to be true, correct and complete. The Applicant authorizes Creditor to investigate all credit references and other sources pertaining to our credit and financial responsibility. The undersigned authorizes its bank and trade creditors to provide Creditor with complete information for the purpose of credit evaluation. The Applicant understands that all past due balances will be subject to a 1.5% per month finance charge. The Applicant further agrees to pay a 25% collection charge in the event of default, if the account is placed with a collection agency or attorney.