CREDIT APPLICATION
*Minimum Required Fields
(If not applicable put N/A)
*LEGAL BUSINESS NAME: 
TRADE NAME (if different from above): 
*Business Type: 
Corporation
LLC
Proprietorship
Partnership
LLP
Non-profit
Date Business Established: 
Federal Tax ID #: 
Sales Tax #: 
Nature of Business: 
Requested Line of Credit: 
Dollar Amount of First Order: 
Parent Company: 
Relationship: 
Division
Subsidiary
Fisal Year End: 
Estimated Annual Sales: 
Estimated Net Worth: 
Billing Address
*Street: 
*City: 
*State: 
*Zip Code: 
Country: 
*Phone: 
Fax: 
Website: 
Shipping Address
Copy above Billing Address
*Street: 
*City: 
*State: 
*Zip Code: 
Country: 
Phone: 
Fax: 
Add another Shipping Address
Accounts Payable Department Contact Information
*1. Name: 
*Email: 
2. Name: 
Email: 
Preferred Invoice Delivery Method: 
Email
Postal Delivery
Other
Email address to receive invoices: 
List of Business Principals / Officers
*Name: 
*Title: 
Name: 
Title: 
Name: 
Title: 
Name: 
Title: 
SUPPLIER AND BANK REFERENCES
Commercial Trade References
at least 3 references required
*1. Company: 
Contact Name: 
Title: 
* Phone Number: 
Fax Number: 
* Email Address: 
*2. Company: 
Contact Name: 
Title: 
* Phone Number: 
Fax Number: 
* Email Address: 
*3. Company: 
Contact Name: 
Title: 
* Phone Number: 
Fax Number: 
* Email Address: 
4. Company: 
Contact Name: 
Title: 
Phone Number: 
Fax Number: 
Email Address: 
5. Company: 
Contact Name: 
Title: 
Phone Number: 
Fax Number: 
Email Address: 
Bank References
1. Bank Name: 
Contact Name: 
Title: 
Phone Number: 
Fax Number: 
Email Address: 
Operating Account Number: 
Loan Account Number: 
Address: 
City: 
State: 
Zip Code: 
Country: 
2. Bank Name: 
Contact Name: 
Title: 
Phone Number: 
Fax Number: 
Email Address: 
Operating Account Number: 
Loan Account Number: 
Address: 
City: 
State: 
Zip Code: 
Country: 
Additional Files:
Select Files to Attach
No Files Attached
PERSONAL GUARANTEE
In consideration of credit being extended by VENDOR to the above named applicant for merchandise to be purchased whether applicant be an individual or individuals, a proprietorship, a partnership, a corporation, or other entity, the undersigned guarantor or guarantors each hereby contract and guarantee to VENDOR the faithful payment, when due, of all accounts of said applicant for purchases made for five years next after the date of this application. The undersigned guarantor or guarantors each hereby expressly waive all notice of acceptance of this guarantee, notice of extension of credit to applicant, presentment, and demand for payment on applicant, protest and notice to undersigned guarantor or guarantors of dishonor or default by applicant or with respect to any security held by VENDOR, extension of time of payment to applicant acceptance of partial payment or partial compromise, all other notices to which the undersigned guarantor or guarantors might otherwise be entitled and demand for payment under this guarantee. Any revocation of this guarantee shall be in writing and delivered to VENDOR at One Corporate Drive, Grantsville, MD 21536
Name: 
Title: 
Signature
Name: 
Title: 
Signature
Name: 
Title: 
Signature
Name: 
Title: 
Signature
Questions or Comments:
Terms and Conditions:
All shipments will be invoiced at prices in effect at time of shipment. Returns without permission including a RA# will not be accepted. A 1 1/2 % per month(18% per year) finance charge will be applied to the unpaid balance of invoices which become 30 days past invoice date. A 15% re-handling charge and applicable commissions will be made on all permissible returns. Permissible returns must be in salable condition. All orders accepted and all agreements are subject to delay caused by accident, strikes, fires and any disasters beyond VENDOR's control. Any adjustments necessary must be brought to our attention, in writing, within 5 days of the receipt of shipment for an adjustment to be made. Please refer to the account number and invoice number on all correspondence. VENDOR's responsibility ceases when goods have been delivered to carrier. Liability - In the event it becomes necessary to enforce payment of this account, or any part thereof, by action of law or otherwise, Applicant agrees to pay all collection costs incurred to collect the amount balance, including reasonable attorney's fees and court costs, venue Circuit Court, Garrett County, Maryland, in addition to incurred service charges, finance charges and processing fees. Applicant agrees that this transaction is subject to all the terms, covenants, promises, and conditions contained therein and agrees to be bound thereby.

The undersigned as an inducement to grant credit warrants that the information submitted is true and correct. VENDOR is hereby authorized to obtain credit record reports of Applicant and Applicant's principals and to investigate the credit, bank and debt references listed above.
* Check to agree. By checking this box I agree to the above Terms and Conditions.
This Application may be signed digitally and facsimile signatures will be considered as originals.
(use your mouse to write your signature)
*Authorized Agent: 
*Title: 
*Signature
Authorized Agent: 
Title: 
Signature
PO Box 600, Grantsville, MD 21536
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