Customer Credit Application Template

Date: [Date]
Requested Credit Terms: ☐ Net 15 ☐ Net 30 ☐ Net 45 ☐ Net 60 ☐ Other: [Terms]
Requested Credit Limit: $[Amount]

1. Customer Information

1.1 Customer Type: ☐ Individual ☐ Business
1.2 Customer Name / Business Legal Name: [Name]
1.3 DBA/Trade Name (if applicable): [DBA]
1.4 Tax ID (EIN/VAT) (if business): [ID]
1.5 Primary Phone: [Phone]
1.6 Email: [Email]
1.7 Website (if business): [URL]

2. Addresses and Contacts

2.1 Billing Address: [Address]
2.2 Shipping Address: [Address] ☐ Same as billing
2.3 Accounts Payable Contact (if business): [Name, email, phone]
2.4 Purchasing Contact (if business): [Name, email, phone]

3. Business Details (If Applicable)

3.1 Entity Type: ☐ LLC ☐ Corporation ☐ Partnership ☐ Sole Proprietor ☐ Other: [Type]
3.2 State/Country of Formation: [State/Country]
3.3 Years in Business: [__]
3.4 Industry: [Industry]
3.5 Owner/Officer Name (Optional): [Name] — Title: [Title]

4. Bank Reference (Optional)

4.1 Bank Name: [Bank]
4.2 Account Type: ☐ Checking ☐ Savings ☐ Other: [Type]
4.3 Bank Contact (Optional): [Name/phone]

5. Trade References (Optional)

Provide [__] trade references (if available):

5.1 Reference #1: Company: [Name] — Contact: [Name] — Phone/Email: [Contact] — Terms: [Net __]
5.2 Reference #2: Company: [Name] — Contact: [Name] — Phone/Email: [Contact] — Terms: [Net __]
5.3 Reference #3: Company: [Name] — Contact: [Name] — Phone/Email: [Contact] — Terms: [Net __]

6. Credit Terms and Conditions

6.1 Payment Obligation. Customer agrees to pay invoices according to approved terms.
6.2 Late Fees (Optional). Late fees: []% per month (or maximum allowed by law) on past-due balances after [] days.
6.3 Collections (Optional). Customer agrees to pay reasonable collection costs and attorneys’ fees where permitted by law.
6.4 Disputes. Invoice disputes must be submitted in writing within [__] days of invoice date.
6.5 Credit Limit Changes. Provider may adjust credit limits based on payment history and risk review.

7. Authorization and Privacy

7.1 Authorization. Customer authorizes Provider to verify this application, including contacting references and obtaining credit information.
7.2 Privacy. Provider will use application information only to evaluate and manage the credit account, subject to applicable law.

8. Personal Guarantee (Optional)

☐ Not included
☐ Included. If included, the undersigned personally guarantees payment of Customer obligations, to the extent permitted by law.

Guarantor Name: [Full name]
Address: [Address]
Phone/Email: [Contact]

Signatures

Customer (Authorized Representative): [Name]
Title/Role (if business): [Title]
Company (if applicable): [Company Name]
Date: [Date]
Signature: ___________________________