Credit Application for a Business Account
Download Form: Credit Application and Bank Credit Reference Form – 2024 FORM
CONTACT INFORMATION
TIN:
DUNS:
Company name:
Phone:
Fax:
E-mail:
Registered company address:
City:
State:
ZIP Code:
Date business commenced:
Sole proprietorship:
Partnership:
Corporation:
Other: BUSINESS AND CREDIT INFORMATION
Primary business address:
City:
State:
ZIP Code:
How long at current address?
Telephone:
Fax: Account Payable E-mail:
Bank name:
Bank address:
E-mail:
City:
State:
ZIP Code:
Type of account:
Account number:
Savings
Checking
Other BUSINESS/TRADE REFERENCES
1) Company name:
Address:
City:
State:
ZIP Code:
Phone:
Fax:
E-mail:
Type of account:
2) Company name:
Address:
City:
State:
ZIP Code:
Phone:
Fax:
E-mail:
Type of account:
3) Company name:
Address:
City:
State:
ZIP Code:
Phone:
Fax:
E-mail:
Type of account:
4) Company name:
Address:
City:
State:
ZIP Code:
Phone:
Fax:
E-mail:
Type of account:
5) Company name:
Address:
City:
State:
ZIP Code:
Phone:
Fax:
E-mail:
Type of account:
AGREEMENT
1. All invoices are to be paid 30 days from the date of the invoice.
2. Claims arising from invoices must be made within seven working days.
3. By submitting this application, you authorize [Company Name] to make inquiries into the banking and business/trade references that you have supplied.
SIGNATURES
Name:
Title:
Date:
Bank Credit Reference Form
To be completed by the Customer
To:
________________________________ Date: _____________________
________________________________
________________________________
Dear Bank Officer:
You are hereby authorized to release information about our accounts, outstanding credit line, and payment history to Persistent Systems, LLC to be used solely to establish an account, a credit line, and payment terms. This information is to be kept strictly confidential.
Signed: ____________________________
Print Name: ________________________
Title: ______________________________
Company: __________________________
Bank Account No: ____________________
Bank Email _______________________
To be completed by the Bank
Dear Sir /Madam,
The above customer has given its bank name as a Credit Reference. We would appreciate it if you would provide the credit information for us by filling in the portion below. Please be rest assured that all information provided will be kept strictly confidential. Should you have any questions, please call us at 212-561-5895 and ask for our Accounting Department. Thank you for your help and prompt attention to this request.
Sincerely,
Accounting Department
Persistent Systems, LLC
Account Since: __________________________ Loan relationship? □ Yes □ No
Current Balance: ________________________ Line of Credit: __________________________
Average Balance: ________________________ Open Date: ____________________________
N.S.F. Checks? □ Yes □ No Secured? □ Yes □ No
If yes, how many? ________________________ Outstanding Balance: ____________________
Overall Credit Rating: ______________________________________________________________________________________
Remarks / Comments: _____________________________________________________________________________________
Completed By: ____________________________ Date: _________________________