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Application for Credit and Trade Recognition


 

International Customers: please download and complete the International Confidential Application for Credit and Trade Recognition.

 
Business Name: *
Billing Address (Street or P.O. Box): *
City: * State: Zip Code: Country:
Business Phone: Business Fax:
E-mail Address: Check if member of:   CBA or ABA
Shipping Address (if different from billing):
City:   State: Zip Code: Country:
Business Type:  Corporation LLC Sole Proprietorship Partnership
Date Business Established (mm-dd-yyyy): * Length of Ownership (in years):
Business Hours: Last Year's Sales:
Sales Year to Date:   Retail Sales Tax License #
Tax-Exempt-501C3 # Employer Identification Notice (EIN) #
Web Address:

Provide Partners or Proprietor Contact Information:

Name: Title:
Home Address:  
City: State: Zip Code: Country:
Daytime Phone: Cell/Other:
Home Phone:   Social Security No:
Name: Title:  
Home Address:
City: State: Zip Code: Country:
Daytime Phone: Cell/Other:
Home Phone: Social Security No:

Provide Authorized Personnel Contact Information: Accounts Payable / Manager / Buyer
Name: Title:
Daytime Phone: Cell/Other:


Name: Title:
Daytime Phone: Cell/Other:

Has the firm or any of its principals previously applied for an account with Anchor Distributors? Yes No
If yes, please list name and complete address of previous account:
Has the firm or any of its principals ever filed for bankruptcy?  Yes  No
If yes, please explain:
Payment Preference: Business Check Money Order Credit Card
Debit Card C.O.D. Wire
Term Account with requested Credit Limit: $

References:

Company Name: Account # Credit Line:
Phone: Fax: Date Established (mm-dd-yyyy): 
Company Name: Account # Credit Line:
Phone: Fax: Date Established (mm-dd-yyyy):


 

All answers are true and correct to the best of my/our knowledge.  By selecting "I AGREE" below, I/we attest to the financial solvency, ability, and willingness to pay all obligations as they come due. Authority is hereby given to trade/bank references allowing the release of credit history to Anchor Distributors.

I AGREE *