Printable Credit Application
         
Phone: 404-969-1001
Fax: 404-969-1005
RETURN TO SUPPORT DESK

Company Information

Company Name____________________________________ GA License #__________________

Address__________________________________________________________________________

City, State, Zip____________________________________________________________________

Telephone(s)_________________________________ Fax_________________________________

Type of Business_____________________________________ Years in Business_____________

Type of Ownership: Sole Owner__________ Partnership__________Corporation___________

Person to contact on Accounts Payable:_____________________________________________

_________________________________________________________________________________

Ownership Information

List all Owners, Partners and Corporate Officers

  1. Name, Title, Phone__________________________________________________________

  2. Name, Title, Phone__________________________________________________________

  3. Name, Title, Phone__________________________________________________________

  4. Name, Title, Phone__________________________________________________________

  5. Name, Title, Phone__________________________________________________________

If in business less than three years provide 2 personal references for each person listed above.

References:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Financial References

  1. Bank, Name, Address________________________________________________________

          Phone____________________________ Account #________________________________

  1. Bank, Name, Address________________________________________________________

          Phone____________________________ Account #________________________________

Trade References

  1. Company, Contact, Phone __________________________________________________

  2. Company, Contact, Phone __________________________________________________

  3. Company, Contact, Phone___________________________________________________

  4. Company, Contact, Phone __________________________________________________

  5. Company, Contact, Phone___________________________________________________

INQUIRES OF COMPETING FIRMS ARE ANONYMOUS

 

I hereby certify that the above information is true and correct.

Signed_________________________________ Title____________________ Date____________

All information contained herein or gathered is held as confidential and used only in the determination of the level of risk taken in our granting credit to the requesting company.

The BENCHMARK Group - 617 Roswell Street - Marietta, GA 30060
www.TheBenchmarkGroup.com