Business Credit Reports

Company Information

Company Name

Address

City

State/Province

Zip/Postal Code

Phone

Billing Address

Billing City

Billing State/Province

Billing Zip/Postal Code

Tax Identification #

Type of Business

Legal Form (Corporation, Partnership, or Proprietorship)

UBI#

Contractor LIC#

WA Reseller#

Registration State

Contact Information

First Name

Last Name

Title

Phone

Accounts Payable Contact Information

First Name

Last Name

Phone

Owner/Partner Information (only needed if partnership or sole proprietorship)

Name

Address

City

State

Phone

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)

Supporting Documentation

Please include a copy of your reseller permit and any other supporting documentation here.

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

I warrant that the information provided in this application is true, complete, and is given for the purpose of obtaining credit and one or more commercial accounts from DTG Enterprises, INC ("DTG"). DTG, or its designee, will rely on this information and is authorized to periodically contact any or all of the above references regarding the applicant's credit standing/rating and/or obtain a business and/or consumer credit report regarding applicant's and/or any principal's credit status. I have read the above terms and conditions stated and hereby agree to abide by 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 DTG Enterprises, 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.

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