Credit Application

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creditappedit2_141199171 Download Credit Application (pdf)

Fax completed credit application to: (818) 727-1054

To apply online, please fill out the form below:

Colum1 Start
Name*
First Last
Company Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Trade Name and/or Billing Address - if different from above:
Type of Business
- Proprietor
- Partnership
- Corporation
- LLC
State of Incorporation:
Untitled
FEIN
Applicant was established or incorporated in
Date
Date Format: MM slash DD slash YYYY
Applicant's present place of business
- Own
- Rent
Is Applicant Tax Exempt: If yes, applicant is required to provide a valid sale/exemption certificate for each ship-to State into which sales are made to sellers
- Yes
- No
Bank Reference Name
Loan OfficerName
First Last
Bank Phone:
Bank Account Number
Bank Reference Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
A copy of Applicant's last full year audited Financial Statement is included with this application:
- Yes
- No
Accounts Receivable Encumbered by a Lien or Security Interest
- Yes
- No
Inventory Encumbered by a Lien or Security Interest
- Yes
- No
Equipment Encumbered by a Lien or Security Interest
- Yes
- No
Upload File
Drop files here or

Accepted file types: jpg, gif, png, pdf, xls, xlsx, doc, docx.
Column1 Ends
Column 2 starts
Phone*
Fax
Email*
Accounts Payable Contact:
Principal Stockholder/Partner:
First Last
Principal Stockholder/partner Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Supplier Reference 1 Name
Supplier Reference 1 Phone
Supplier Reference 1 Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supplier Reference 2 Name:
Supplier Reference 2 Phone
Supplier Reference 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Supplier Reference 3 Name
Supplier Reference 3 Phone
Supplier Reference 3 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Column2 ends

By clicking the SUBMIT button:

Applicant hereby certifies that the information furnished under this Application and any other financial statements furnished in connection herewith, is true and correct and that this information is being furnished to Seller for the purpose of inducing Seller to extend credit to Applicant, and understands that Seller intends to rely upon such information. Seller’s “Terms and Conditions of Sale and Service” shall apply to any transactions between Seller and Buyer, unless other terms are agreed to by Seller in writing.

Applicant hereby authorizes Seller to check Applicant’s credit history and trade and bank references for customary credit information now and hereinafter, and to confirm on a continuing basis the information contained on this Application including but, not limited to, sending a copy hereof to the trade and bank reference, and to release information to other creditors regarding Applicant’s credit experience with Seller.

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Credit Application

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