Credit Application

Corporate Info

Legal Business Name: required

Legal business name is required.

Date Established: required

Date established is required.

Phone Number: required

Phone number is required.

Trade Name: if different from legal name / dba

Fax Number:

Address: required

Address is required.

City: required

City is required.

State: required

State is required.

Zip: required

ZipCode is required.

Salesperson:

Your Name:

Accounts Payable Contact

Contact Name: required

Contact name is required.

Contact Phone: required

Contact phone is required.

Contact Email: required

Contact email is required.

Digital Invoice Delivery Email: required

Digital invoice delivery email is required.

Corporate Profile

Tax ID / Fed ID:

D&B Number:

Stock Symbol:

Annual Sales Volume: required

Annual sales volume is required.

Bank / Trade Reference

Must have account number under same dba and/or legal name

Bank Name: required

Bank name is required.

Checking Account #:

Savings Account #:

Loan Account #:

Contact Name: required

Contact name is required.

Contact Phone: required

Bank contact phone is required.

Contact Email: required

Bank contact email is required.

Trade References

Please provide at least 3 trade references

You may also attach/upload reference files:

Name:

Terms:

Address:

Phone:

Credit Request

Account Terms Requested: required

Account terms requested is required.

Requested Credit Limit: required

Tax-Exempt Organizations

Optional

Please attach/upload any exemption certificate(s):

Certify Information / Financial Release

I certify that the above information is true and correct. Furthermore, I authorize financial institutions to release necessary information to Integrated IT Solutions LLC in order to verify the information contained herein.