Date : _________________
Credit Application and Agreement
1. COMPANY INFORMATION
| Full legal name/business entity | Phone number | Fax number | |
| Doing business as (DBA) | |||
| Billing address (if different from above) | City | State | Zip |
| Company type: o Proprietorship o Partnership o Franchisee o Corporation o Other: |
|||
2. BUSINESS CREDIT INFORMATION
| Federal tax I.D. (If incorporated) | Principal business of firm | Year business established |
| At present location since | Is business incorporated? | If so, under laws of what state? |
| Credit line requested | Incorporated for $ | |
* Please list all branch/affiliate store operations on page 2 of application
3. BANK REFERENCES
| Bank name | Account # | Contact | ||
| Address | City | State | Zip | Phone |
| Bank name | Account # | Contact | ||
| Address | City | State | Zip | Phone |
| Bank name | Account # | Contact | ||
| Address | City | State | Zip | Phone |
4. CREDIT REFERENCES
| Company name | Contact | |||
| Address | City | State | Zip | Phone |
| Company name | Contact | |||
| Address | City | State | Zip | Phone |
| Company name | Contact | |||
| Address | City | State | Zip | Phone |
1. PROPRIETOR AUTHORIZATION
By signing this application, I authorize PEOPLEofAMERICA.com or its agents to request and
obtain consumer credit reports on me and my company in connection with the opening,
monitoring, renewal and extension of this and other accounts with PEOPLEofAMERICA.com and
the marketing of other products and services to me and my business by PEOPLEofAMERICA.com.
I further authorize PEOPLEofAMERICA.com to share the information received from my credit
report with PEOPLEofAMERICA.com's parent, subsidiaries and affiliates (and others if
applicable).
2. PROPRIETOR GUARANTY
By signing this application, I acknowledge that I have personally guaranteed the debts and
obligations of my business and agree that I am personally obligated to perform all of the
terms of, and make all payments to PEOPLEofAMERICA.com required by, the agreement of which
this application is a part. I futher agree to PEOPLEofAMERICA.com's Terms and Conditions
as stated on their website (http://PEOPLEofAMERICA.com/new_accounts.htm).
| First name | Initial | Last name | Social Security number |
| Present home address | Home phone number | ||
| City | State | Zip | |
| Authorized signature | Date | ||