Credit Application | PromoCentric

Credit Application.

Legal Business Name(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

AP Email(Required)

Website Address(Required)

Business Start Date (approx)(Required)

Type of Business(Required)

Whom should we contact on credit matters?(Required)

Annual Sales(Required)

Number of Employees(Required)

Bank Reference.

Bank Name(Required)

Bank Contact Person(Required)

Bank City(Required)

Bank State(Required)

Bank Email(Required)

Bank Phone Number(Required)

Bank Fax

Trade References.

3 are required – please supply the following information for each:

Business Name, Account #, Contact Name, First and Last Name, Phone Number with area code, Fax number, Email Address.(Required)