Credit Application Form

Credit Application Form Template

[Creditor/Lender Name]
[Address]
[Phone] [Email] [Website]
Application Date: [MM/DD/YYYY]
Application Type: [Individual / Joint / Business]

1. Applicant Information

Legal Name: [First Middle Last or Business Legal Name]
DBA (if any): [Name]
Entity Type (for business): [LLC/Corp/Sole Prop/Partnership/Nonprofit]
Tax ID / SSN / EIN: [Number]
Date of Birth (for individual): [MM/DD/YYYY]
Incorporation/Formation Date (for business): [MM/DD/YYYY]
Primary Address: [Street, City, State/Province, Postal Code, Country]
Phone: [Number] Email: [Address]
Website (if any): [URL]

2. Employment or Business Profile

For individuals:
Employer: [Name] Title: [Role] Start Date: [MM/YYYY]
Employer Address: [Address] Phone: [Number]
Monthly Gross Income: [Amount] Other Income (source/amount): [Details]

For businesses:
Primary Contact: [Name, Title, Email, Phone]
Industry/NAICS: [Code/Description]
Number of Employees: [#]
Annual Revenue (last fiscal year): [Amount]
Current Year YTD Revenue: [Amount]
Ownership Structure and Percentages: [List owners and %]

3. Credit Request

Requested Credit Type: [Revolving/Net Terms/Installment/Lease/Other]
Requested Credit Limit/Amount: [Amount]
Requested Terms: [e.g., Net 30, APR %, Tenor]
Intended Use of Credit: [Working capital, equipment, inventory, etc.]

4. Banking Information

Primary Bank: [Name] Branch: [Location]
Account Type(s): [Checking/Savings/Operating]
Account Number (last 4): [XXXX]
Bank Contact: [Name/Phone/Email]

5. Trade References (for business or contractor accounts)

Reference 1: [Company, Contact, Phone/Email, Account #, Average Monthly Balance/Terms]
Reference 2: [Company, Contact, Phone/Email, Account #, Average Monthly Balance/Terms]
Reference 3: [Company, Contact, Phone/Email, Account #, Average Monthly Balance/Terms]

6. Financial Information

For individuals (attach recent pay stubs or tax return if requested):
Monthly Housing Payment: [Amount] Own/Rent: [Own/Rent]
Assets (cash/investments/vehicles/real estate): [Summary and estimated values]
Liabilities (loans/credit cards/other): [Summary and balances]

For businesses (attach financials as requested):
Latest Fiscal Year Financials: [Attached Y/N]
Interim Financials (YTD): [Attached Y/N]
Accounts Receivable (current/30/60/90+): [Aging summary]
Accounts Payable (current/30/60/90+): [Aging summary]
Existing Debt Schedule: [Lender, balance, rate, maturity]

7. Authorized Users / Signers

List individuals authorized to place orders or draw on the account.
Name 1: [Name, Title, Phone, Email]
Name 2: [Name, Title, Phone, Email]

8. Certifications and Consents

By signing, the undersigned certifies that the information provided is true, correct, and complete and authorizes the creditor to:

• Obtain consumer and/or commercial credit reports, bank references, and trade references now and in the future for account review, maintenance, or collection.

• Verify employment or business information and contact references and financial institutions.

• Share application data internally and with service providers for underwriting, fraud prevention, and account servicing consistent with applicable law.
  The applicant agrees to notify the creditor of any material changes to the information provided.

9. Terms and Conditions Acknowledgment

If approved, the account will be governed by the creditor’s credit agreement or account terms, including payment obligations, late fees, finance charges, and remedies upon default. Applicant acknowledges receipt or availability of those terms and agrees to be bound upon acceptance of credit.

10. Personal Guaranty (if required for business credit)

In consideration of the extension of credit to the applicant business, the undersigned guarantor(s) unconditionally guarantee payment and performance of all obligations, including costs of collection and reasonable attorney’s fees, under the account terms. This is a continuing guaranty and may be revoked in writing prospectively as to future credit only.

Guarantor Name: [Full Name]
Home Address: [Address]
SSN/Tax ID (last 4): [XXXX]
Signature: __________________________ Date: __________

Guarantor Name: [Full Name]
Home Address: [Address]
SSN/Tax ID (last 4): [XXXX]
Signature: __________________________ Date: __________

11. Compliance and Disclosures

Anti–money laundering and sanctions compliance: applicant represents it is not a prohibited party and will not use credit for unlawful purposes. If applicable, attach KYC/KYB documents (ID, business registration, beneficial ownership). The creditor’s privacy notice and adverse action disclosures will be provided as required by law.

12. Attachments Checklist

Individuals: government ID, proof of address, income verification (pay stubs/tax return).
Businesses: formation documents, certificate of good standing, ownership list, financial statements, AR/AP aging, tax returns (if requested), resale/exemption certificates (if relevant).