Credit Application

5519 Ayon Ave, Irwindale, CA 91706
Tel: 626-815-8828 Fax: 626-815-2889
*Please attach a copy of your business license (Please included a copy of your resale permit)

1. Company Information
Business Entity:
Billing Address:
City:
State:
Zip:
Phone:
Fax:
Doing Business As (DBA):
Company Type:
No. Of Employees:
Year Established:
Annual Sales:
Federal Tax ID:
State of Incorporation:
E-Mail Address:
Website:

2. Owner Information
Full Name (include initial):
Title:
Social Security No:
Home Address:
City:
State:
Zip:
Phone:

3. Bank References
Bank:
Account No:
Contact:
Address:
City:
State:
Zip:
Phone:

4. Trade Credit References
Company Name:
Contact:
Address:
City:
State:
Zip:
Phone:

I hereby apply for credit and affirm financial responsibility, ability and willingness to pay invoices in accordance with published terms. The above information is warranted to be true and complete. We hereby authorize you to verify and collect information on us, including but not limited to bank references, trade credit references, consumer and/or commercial credit reports.