CREDIT
APPLICATION
YOU
MAY
ATTACH
A CREDIT SHEET
Business Name
Phone(541)459-5571
BillingAddress_________________________________
Fax
to:(541)459-5571
City,
State andZip _____________________________
Phone(
)
Street/Shipping
Address_______________________ Fax Number(
)
Fed.ID#or
SS#____________
Proprietership __
Partnership__
Corporation__
Years in this business______Monthly credit limit
requested$______________
Have you or any of the principles in your company ever declared
bankruptcy?:________
Proprietors,
Partners, or Officers
Name______________________Title_____________Address______________________
Name______________________Title_____________Address______________________
Subsidiaries, Affiliates, Parent Companies, or
DBA________________________________
Bank References
Name_____________________________________Phone(
)
Account#s_________________________________Loan
Officer_____________
Trade
References
1)Trade
Reference__________________________________Phone(
)
Address________________________________________Account
Number______________
City, State and
Zip_______________________________
2)Trade
Reference__________________________________Phone(
)
Address________________________________________Account
Number______________
City, State and
Zip_______________________________
3)Trade
Reference__________________________________Phone(
)
Address________________________________________Account
Number______________
City, State and Zip_______________________________
4)Trade
Reference__________________________________Phone(
)
Address________________________________________Account
Number______________
City, State and
Zip_______________________________
Applicant agrees to
notify
Quicksilver
Engineering
promptly of any changes in ownership of the business. Until
Quicksilver Engineering receives written notice of any changes in
ownership, applicant agrees to accept liability for all charges to the
business conducted under firm name, regardless of Applicant's actual
relationship with the new owner.
Applicant's signature attests to applicant's
financial responsibility and willingness to pay Quicksilver Engineering
invoices. Applicant authorizes Quicksilver engineering to investigate
the references listed pertaining to applicant's credit and financial
responsibility, and authorizes disclosure of information relating to
applicant's credit and financial responsibility to Quicksilver
Engineering.
Signed by:______________________________Title*_____________Date_______
*Applications
received without
signature of President or Owner
will be returned
(President,
Owner)
