Credit Application

Title

Company Name *

Phone

Fax

Email *

Registered Company Address

Address Line 1

Address Line 2

City

State

Zip Code

Date Business Commenced

Date

Time

Business Type

Sole Proprietorship
Partnership
Corporation
Other

Business and Credit Information

Primary Business Address

Address Line 1

Address Line 2

City

State

Zip Code

How Long at Current Address?

Business Telephone

Business Fax

Business Email

Banking Information

Bank Name

Bank Contact

Bank Contact Email

Bank Address

Address Line 1

Address Line 2

City

State

Zip Code

Bank Phone

Type of Bank Account

Savings
Checking
Other

Bank Account Number

Business / Trade Reference 1

Reference 1 - Company Name

Reference 1 - Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference 1 - Phone

Reference 1 - Fax

Reference 1 - Email

Reference 1 - Type of Account

Business / Trade Reference 2

Reference 2 - Company Name

Reference 2 - Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference 2 - Phone

Reference 2 - Fax

Reference 2 - Email

Reference 2 - Type of Account

Business / Trade Reference 3

Reference 3 - Company Name

Reference 3 - Address

Address Line 1

Address Line 2

City

State

Zip Code

Reference 3 - Phone

Reference 3 - Fax

Reference 3 - Email

Reference 3 - Type of Account

Agreement

By submitting this application, you agree to the following terms: 1. All invoices are to be paid 30 days from the date of the invoice. 2. Claims arising from invoices must be made within seven working days. 3. By submitting this application, you authorize XL INDUSTRIES, INC. to make inquiries into the banking and business/trade references that you have supplied.

Agreement Acceptance *

I agree to the terms above and authorize XL Industries, Inc. to verify the information provided.

Authorized - Name *

First

Last

Primary signatory

Authorized - Title

Signature *

Clear Signature

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