Business Credit Reports

Company Information

Company Name

DBA or Trade Name

Address

City

State/Province

Zip/Postal Code

Country

Telephone Number

Fax Number

Year Established

Legal Form (Corporation/LLC/Partnership/Proprietor/Other - Explain)

Will Your Purchase Be Tax Exempt? (If Exempt, Exemption or Resale Certificate(s) Must Be Provided)

Contact Information

First Name

Last Name

Title

Phone

Accounts Payable/Billing Information

Mailing Address

City

State

Zip

Telephone Number

Fax Number

A/P Contact

Email Address

Would You Prefer To Have Invoices Emailed?

If Yes, What Email Address Should We Send Invoices To?

Ownership Information

Parent Company / Owner Name

Parent Company / Owner Address

City

State

Zip

How Long Has The Above Owned The Applicant's Business?

Corporate Officers

Name

Title

Name

Title

Name

Title

Has The Firm Or Any Of Its Principals Ever Been A Party In A Bankruptcy? (Yes/No)

If Yes, Please Explain

Bank Information

Bank Name - Branch

Mailing Address

City

State

Zip

Bank Officer/Contact

Account Number

Telephone Number

Fax Number

Trade Reference #1

Name

A/R Contact

Mailing Address

City

State

Zip

Acct #

Telephone Number

Fax Number

Trade Reference #2

Name

A/R Contact

Mailing Address

City

State

Zip

Acct #

Telephone Number

Fax Number

Trade Reference #3

Name

A/R Contact

Mailing Address

City

State

Zip

Acct #

Telephone Number

Fax Number

Trade Reference #4

Name

A/R Contact

Mailing Address

City

State

Zip

Acct #

Telephone Number

Fax Number

Request

Requested Amount

Comments (400 characters max)

Supporting Documentation

If Tax Exempt, exemption or resale certificate(s) must be provided.

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

Credit terms are Net 30 days. Invoices not paid within 30 days of invoice date will be assessed a 1.5% per month Finance Charge. [In accordance with the Usury laws of the state]. I/We understand and agree that the information provided is for the purpose of obtaining credit. I/We further understand and agree that all accounts or monies due to A&C Plastics, Inc. shall be paid in accordance with the Credit Terms stated above and agree to pay all reasonable costs of collection, in addition to any court costs and/or attorney fees incurred. I/We authorize investigation of all credit references and credit history. I/We authorize creditors to release information pertaining to my/our credit history. I/We further authorize investigation of my/our credit via credit bureau reports.

Please allow up to 2 weeks for credit approval.

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 A&C Plastics 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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