Business Credit Application

Please provide the following information:

Name of Business or Farm

Street Address

City

State    Zip Code

Billing Address    Zip Code

Phone    Fax



Corporations only

State of Incorporation

Date of Incorporation

President

If not Incorporated:

Name of Owner    SSN

Address      Birthdate

Nature of Business

Bank Reference      Phone

Credit References (Name, Address, Phone, Fax)

Please read the following carefully before submitting this form:

I / We are financially able to meet any commitments made, and agree to pay your invoices according to your terms. I / We hereby authorize you to verify the information submitted above, and / or to order trade credit reports at your discretion. I / We understand that your terms are net due the 15th of the month following invoice date, and past-due accounts are subject to a 1.5% per month service charge (18% annual rate), which we also agree to pay if account becomes delinquent. I / We further understand that failure to comply with the above terms will cause Home of Economy to revoke out open account privileges.

	Name of Business or Farm
	Street Address
	City
	State		Zip Code
	Billing Address		Zip Code
	Phone		Fax

	*Corporations only*
	State of Incorporation
	Date of Incorporation
	President

	*If not Incorporated:*
	Name of Owner		SSN
	Address		Birthdate

	Nature of Business
	Bank Reference		Phone

	Credit References	(Name, Address, Phone, Fax)




*Please read the following carefully before submitting this form:*
I / We are financially able to meet any commitments made, and agree to pay your invoices according to your terms. I / We hereby authorize you to verify the information submitted above, and / or to order trade credit reports at your discretion. I / We understand that your terms are net due the 15th of the month following invoice date, and past-due accounts are subject to a 1.5% per month service charge (18% annual rate), which we also agree to pay if account becomes delinquent. I / We further understand that failure to comply with the above terms will cause Home of Economy to revoke out open account privileges.