Business Credit Reports

Company Information

Company Name

Address

City

State/Province

Zip/Postal Code

Country

Type of Business

# of Years in Business

Legal Form (Corporation, Partnership, or Proprietorship)

Tax Identification #

Resale #

Contact Information

First Name

Last Name

Title

Phone

Accounts Payable Contact Information

First Name

Last Name

Title

Phone

Bank Reference

Name

Address

City

State

Zip

Account #

Phone #

Trade Reference #1

Name

Address

City

State

Zip

Contact

Trade Reference #2

Name

Address

City

State

Zip

Contact

Trade Reference #3

Name

Address

City

State

Zip

Contact

Request

Requested Amount

Comments (400 characters max)

Supporting Documentation

Please upload a copy of your Tax Exemption Certificate or Resale Certificate, if applicable.

Click the Browse / Choose Files button above to select the files you want to send. Then click the Upload button.
Please keep individual file sizes to 4MB or less.

Uploaded Documents

Terms

OUR TERMS ARE STRICTLY NET 30.

The execution of this document makes it incumbent upon behalf of the company. Should delinquency occur, company by acknowledge of the executor would be liable for any and all collection expenses, including third party intervention, court costs, and reasonable attorney fees.

I certify that all the above information is correct and I authorize the creditors listed to provide credit information to American Dish Service.
I understand that ADS may use the information provided to check the personal credit of the owners or principals.

I accept the above terms.

Please Sign Below

Using a touchpad or mouse, please sign in the area below. When finished signing, please click the Save Signature.

Submit the Request

By clicking 'Submit', I/We authorize AMERICAN DISH SERVICE 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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