Credit Application (Net 30)

Business

Legal business name *

DBA (if different)

Business address (street, city, state, ZIP) *

Federal EIN *

Business type (corp, LLC, sole prop, gov)

Years in business

Website

Est. monthly purchases ($)

Accounts payable contact

AP contact name *

AP email (we reply here; invoices go here) *

AP phone

Trade reference 1

Ref 1 company *

Ref 1 contact name *

Ref 1 email or phone *

Trade reference 2

Ref 2 company *

Ref 2 contact name *

Ref 2 email or phone *

Bank reference (optional)

Bank name and contact

Signature

By submitting, I confirm I'm authorized to apply for credit for this business and that Supply Tie may contact the references above. If approved, invoices are due 30 days from invoice date.

Authorized signer (full name and title) *

Date *

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