Business Credit Reports

Company Information

Company Name

Address

City

State/Province

Zip/Postal Code

Country

Phone

Fax

Billing Name

Billing Email

Legal Form (Corporation, Partnership, or Proprietorship)

# of Years in Business

DUNS #

Tax Identification #

Annual Sales $

# of Employees

Have you ever applied for credit from us before? (Yes or No)

If yes: Company Name & Account #

Have you ever filed for Bankruptcy? (Yes or No)

If yes: Date, City & State of Filing

Contact Information

First Name

Last Name

Phone

Accounts Payable Contact Information

First Name

Last Name

Phone

Credit Reference #1

Company

Account #

Address

City

State

Zip

Phone

Fax

High Credit $

Years In Business

Credit Reference #2

Company

Account #

Address

City

State

Zip

Phone

Fax

High Credit $

Years In Business

Credit Reference #3

Company

Account #

Address

City

State

Zip

Phone

Fax

High Credit $

Years In Business

Requested Amount

Request

Requested Amount

Comments (400 characters max)

Terms

The information contained in this Application is provided for the purpose of obtaining or maintaining credit with Green Sprouts, Inc.. The undersigned understands that Green Sprouts, Inc. is relying on the information provided herein in deciding to grant or continue credit. The undersigned represents and warrants that the information provided is true and complete and may be considered as continuing to be true and correct until a written notice of change is given to Green Sprouts, Inc. by the undersigned. Green Sprouts, Inc. is authorized to make all inquiries deemed necessary including but not limited to pulling consumer credit reports on any owners or principals of the company in order to verify the accuracy of the statements made herein to determine by creditworthiness.

Conditions: Payment terms are Net 30 days upon credit approval unless otherwise specified. Additional terms of sale including terms of payment and allowable discounts for each purchase are agreed to and will be specified on the face of each invoice. Balances carried past the due date or over established credit line may cause delays with processing new orders. The customer hereby agrees to pay all collection and legal fees incurred, if such action be necessary, including but not limited to legal fees, expenses, as well as interest at 1.5% per month/ 18% per annum interest on any past due invoices or the maximum legal rate permitted by the state and any non-sufficient fund charges as allowed by law in the event of a returned check. I have read these conditions and hereby agree to them.

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 Green Sprouts, Inc. 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