Credit Application

Applicant Information

Legal Name of Company:

DBA Name(s):

D&B (D-U-N-S) No.:

Federal ID Number:

Year Started:

Primary Contact Email:

Legal Form of Business:

Tax Status:

Executive Officer Name, Title:

Financial Officer Name, Title:

Primary Contact Name:

Requested Credit Amount ($):

Parent Company (if Division/Subsidiary):



State or Prov:

Zip Code:


Phone #:

Primary Bank

Institution Name:

Primary Bank Address:

Primary Bank Contact:

Primary Bank Phone:

Trade Reference

Trade Reference 1:

Address-Trade Ref 1:

Contact Name, Email – Trade Ref 1:

Phone-Trade Ref 1:

Credit Line ($) -Trade Ref 1:

Years Doing Business – Trade Ref 1:

Trade Reference 2:

Address-Trade Ref 2:

Contact Name, Email – Trade Ref 2:

Phone-Trade Ref 2:

Credit Line ($) – Trade Ref 2:

Years Doing Business – Trade Ref 2:

Financials For Most Recent Three Fiscal Years (Amounts in USD)


Pretax Profit – Yr.1:

Revenue – Yr. 1:

Total Assets – Yr.1:

Current Assets – Yr.1:


Pretax Profit – Yr.2:

Revenue – Yr. 2:

Total Assets – Yr.2:

Current Assets – Yr.2:


Pretax Profit – Yr.3:

Revenue – Yr. 3:

Total Assets – Yr.3:

Current Assets – Yr.3: