Business Credit Reports

Company Information

Company Name

Federal Tax ID

Address

D&B #

City

Phone #

State/Province

Fax #

Zip/Postal Code

Country

Corporate/Head Office Address (if different than above)

City/State/Zip

Phone #

Former Business Address (if applicable)

City/State/Zip

Nature of Business

Date Established

Does State, County, or City require a License? (Yes/No)

License #

Ownership (Coprorate/Proprietorship/Partnership/LLC,LLP)

No. of Employees

Est. Annual Sales ($)

Contact Information

First Name

Last Name

Title

Phone

Invoicing Information

Mailing Name (If Different Than Above)

Accounts Payable Contact

Mailing Address (If Different Than Above)

AP Phone #

City

Fax #

State

AP Email

Zip

Country

Billing Requirements

Status of Paying Organization

Tax Exempt Project? (Yes/No)

If Yes, Project Name

Project Location

City/State/Zip

Tax Exempt Non-Profit or Distributor/Reseller? (Yes/No)

Tax Exemption Number

Principal Owners - Stockholders - Partners - Officers of Company

1. Name of Principal

1. Mailing Address

1. City/State/Zip

1. Title

2. Name of Principal

2. Mailing Address

2. City/State/Zip

2. Title

3. Name of Principal

3. Mailing Address

3. City/State/Zip

3. Title

4. Name of Principal

4. Mailing Address

4. City/State/Zip

4. Title

Bank Reference

Bank Name

Banking Official

Address

Type of Account

City

Bank Account #

State

Phone #

Zip

Fax #

Country

Trade References #1

Business Name

Address

City

State

Zip

County

Phone #

Fax #

Trade References #2

Business Name

Address

City

State

Zip

County

Phone #

Fax #

Bankruptcy Information

Has the firm or any of its principles ever been bankrupt? (Yes/No)

If Yes, Please Explain

Authorized Signatory

Authorized Signatory Name

Authorized Signatory Title

Request

Requested Amount

Comments (400 characters max)

Supporting Documentation

If you are Tax Exempt, please upload a copy of your exemption certificate as well.

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 AGREEMENT
Any misrepresentation in this Agreement will be considered evidence of fraud, since this information is the basis for the extending of credit. As an inducement to grand credit, the undersigned warrants that the information submitted is true and correct. Skudo LLC is authorized to investigate the credit references and principles listed.

In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed that being 30 days from the date of the invoice, or COD and agrees to pay a service charge per month of 1-1/2% per month (18% annual percentage rate) on all past due balances. In the event that any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees, whether or not litigation has commenced, and all costs of litigation incurred. The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.

CREDIT RELEASE AUTHORIZATION
For the purpose of obtaining merchandise on credit, I authorize the bank listed above to release credit information to:

Skudo LLC.
11120 Zodiac Lane
Dallas, Texas 75229
(972) 993-0777

As an inducement to grant credit, the undersigned agrees to the need for verification of all information on this agreement and authorizes and releases all banks, businesses and persons identified on this agreement to furnish any and all information requested by Skudo LLC or its representative, by telephone or written correspondence.

The undersigned warrants that the information is true and correct.

As an inducement to grant credit, the undersigned agrees to Skudo LLC’s right to obtain the credit history of the undersigned and authorizes the release of such information by signature here.

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 Skudo LLC 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