Credit Application

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creditappedit2_141199171Download Credit Application (pdf)


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

Or send by e-mail to:


To apply online, please fill out the form below: 



Company Name:
Trade Name and/or Billing Address - if different from above:
Type of Business:
State of Incorporation:
Applicant was established or incorporated in:
Applicant's present place of business:
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.
Bank Reference Name
Loan OfficerName:
Bank Phone:
Bank Account Number:
Bank Reference Address:
A copy of Applicant's last full year audited Financial Statement is included with this application:
Accounts Receivable Encumbered by a Lien or Security Interest
Inventory Encumbered by a Lien or Security Interest
Equipment Encumbered by a Lien or Security Interest
Upload a File:
Word Verification:
Accounts Payable Contact:
Principal Stockholder/Partner:
Principal Stockholder/partner Home Address:
Home Phone:
Supplier Reference 1 Name:
Supplier Reference 1 Phone:
Supplier Reference 1 Address:
Supplier Reference 2 Name:
Supplier Reference 2 Phone:
Supplier Reference 2 Address:
Supplier Reference 3 Name:
Supplier Reference 3 Phone:
Supplier Reference 3 Address:

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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