Business Credit Reports

Company Information

Company Name

DBA

Address

City

State/Province

Zip/Postal Code

Country

Phone

Billing Address

Billing City

Billing State/Province

Billing Zip/Postal Code

Billing Country

Preferred Method of Invoice Submission (Mail, Email, or Online Web-Portal)

Remittance Email if Applicable

Are PO's Required for Payment?

Will the PO be Provided at the Time of the Service Requested?

Tax Identification #

Is Your Company Exempt From Tax? (Please Provide Proper 01-399 Certificate)

Type of Business

# of Years in Business

# of Employees

Previous Address

Website

Contact Information

First Name

Last Name

Title

Phone

Fax

Accounts Payable Contact Information

First Name

Last Name

Title

Phone

Fax

Bank References

Bank

Account #

Phone

Contact

Address

City

State

Zip

Parent Company Information

Company

Address

City

State

Zip

Country

Owner/Partner Information (only needed if partnership or sole proprietorship)

Name

Address

City

State

Zip

Country

Phone

SSN

Previous Company Information (only needed if in business for less than a year)

Previous Company

Address

City

State

Zip

Country

Credit Reference #1

Company

Contact

Phone

Fax

Credit Reference #2

Company

Contact

Phone

Fax

Credit Reference #3

Company

Contact

Phone

Fax

Terms

Please Read and Understand Our Credit Policy: Payment terms for all open accounts are “Net 10 days”. Accounts that reach 60 days past due will automatically be changed to a COD account adding all unpaid invoices. Accounts that reach 90 days past due will automatically be placed on credit hold status until the past due amount is received. You will be notified if your account is past due. For failure to pay the amount owed you will be liable for all cost of collections including attorney fees.

I accept the above terms.

Submit the Request

By clicking 'Submit', I/We authorize A1 Security Group or its agent to obtain a credit report for the purpose of establishing, maintaining or enforcing a credit relationship. Upon approval of credit, I/We agree to pay our account according to the terms granted and I/We acknowledge that I/We have read and fully understand this application.

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