Business Credit Reports

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Company Information

Company Name

# of Years in Business

Address

City

State/Province

Zip/Postal Code

Country

Phone

Fax

Legal Form (Corporation, Partnership, or Proprietorship)

Contact Information

First Name

Last Name

Title

Phone

Fax

Bank References

Bank Name

Address

City

State

Zip

Phone

Account #

Type of Account (Savings, Checking, Other)

Credit Reference #1

Company

Contact

Phone

Fax

Address

Account #

Credit Reference #2

Company

Contact

Phone

Fax

Address

Account #

Credit Reference #3

Company

Contact

Phone

Fax

Address

Account #

Request

Requested Amount

Comments (400 characters max)

Terms

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 Henssgen Hardware Corporation to make inquiries into the banking and business/trade references that you have supplied.

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 Henssgen Hardware Corp 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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