CREDIT APPLICATION

Company Name:
Address:
City:                                                                                     State:                                             Zip:
Phone Number: Fax Number:
Our Legal Entity is:                 r  Corporation        r  Partnership  r  Proprietorship
Date Business Started:

 

Name, Home, Address, Home Phone, Number of Proprietor/Partners/Officers

NAME AND ADDRESS

PHONE NUMBER

TITLE

SS#
FEDERAL ID No. SALES TAX #:
TYPE OF BUSINESS:

 

BANK INFORMATION
Bank Name: Phone Number:
Address:
Account Number: Contact Name:

 

CREDIT REFERENCES
Name and Address Phone Number Account Number

The undersigned authorizes release of all credit information requested by APX.

By accepting the services of APX as described on all invoices it is agreed that any and all collection fees, attorney fees, Court costs or any other expense involved in the collection of these charges shall be payable to the prevailing party by the non-prevailing party.
Accounts Payable Clerk Name:
Name/Title:
Signature: Date:

 

 FOR OFFICE USE ONLY
SALES I.D.:  
TYPE:  
DATE:

 TEL: (877) 597-0258     FAX:(877)597-0259