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Credit Application for Wholesale Customers
Applicant Company Information
Company Name / DBA
Company Address
Office Contact Phone
President / CEO
A/P Contact
Principial Owner Name
Principial Owner Home Address
Email Address
Year of Formation
State of Incorporation
Applicant Firm is: *
Corporation
LLC
Partnership
Proprietorship
Bank Reference
Bank name
Address
State
City
ZIP
Phone
Contact Person
Account number
Credit References
Company (Reference)
Account #
Phone
Contact Person
Address
Company (Reference 2)
Account #
Phone
Contact Person
Address
Company (Reference 3)
Account #
Phone
Contact Person
Address
Confirmation
I confirm that the above information is true and accurate. I, hereby authorize EcoQuality Inc. to contact the references to investigate Applicant’s credit and financial responsibility.
Your Full Name
Date Today
Submit
