Business Credit Reports

Company Information

Company Name

DBA

Address

City

State/Province

Zip/Postal Code

Phone

Billing Address

Billing City

Billing State/Province

Billing Zip/Postal Code

Tax Identification #

Type of Business

# of Years in Business

# of Employees

Website

Legal Form (Corporation, Partnership, or Proprietorship)

Fax

Total Company Revenue

Contact Information

First Name

Last Name

Title

Phone

Fax

Middle Initial

Accounts Payable Contact Information

First Name

Last Name

Title

Phone

Fax

Bank References

Bank Name

Account #

Address

City

State

Zip

Contact

Phone

Fax

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

The information on this application is for the purpose of obtaining credit and is represented by the applicant to be true and complete. The applicant authorizes The Design Squad, Inc. to investigate all credit references and any other matters pertaining to its financial responsibility. The applicant agrees to be responsible for and to pay collection costs and expenses and/or attorneys’ fees incurred by the applicant in the collection of past due amounts, together with interest on such due amounts at the maximum rate permitted by law. The applicant will have a continuing obligation to notify The Design Squad, Inc. of any material change should any occur to the applicants’ business.

* Please note that incomplete information may cause your application delays or to be denied.

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 The Design Squad 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.

Your session is about to expire