Credit Application for a Business Account

"*" indicates required fields

Business Contact / Billing Information:

Company Name*

Company DBA

Company Address*

Street Address City State ZIP Code

Primary Contact Name:*

First Last

Primary Phone:*

Primary Email:*

AP Contact Name:*

First Last

AP Phone:*

AP Email:*

Business Information:

Year business was created:*

Business Type:

Sole Proprietor

C Corporation

Partnership

S Corporation

Other

Tax Exempt:*

Yes

Bank Information:

Bank Name:*

Bank Contact Phone Number:*

Bank Contact Name:*

First Last

Business/Trade References:

Reference #1

Company Name:*

Company Address*

Street Address City State ZIP Code

Contact Name:*

First Last

Contact Phone:*

Contact Email*

Reference #2

Company Name:

Company Address

Street Address City State ZIP Code

Contact Name:*

First Last

Contact Phone:*

Contact Email*

Reference #3

Company Name:

Company Address

Street Address City State ZIP Code

Contact Name:*

First Last

Contact Phone:*

Contact Email*

Authorize SMS Messaging

Authorize SMS Messaging ^[1]

Agreement

By submitting this application, you agree to the following:

1. All Invoices must be paid within 30 days from the date of the invoice.

2. Invoices over $2,000.00 paid with a credit card are subject to an additional 2.5% fee.

3. By submitting this application, you authorize Action Lock Doc to make inquiries into the banking and business references that have been provided.

Title:*

Date*

Printed Name*

First Last

Signature*

^[1] By providing my phone number to Action Lock Doc, I consent to receive conversational, informational, or promotional SMS from Action Lock Doc. Reply STOP to opt-out; Reply HELP for support; Message and data rates apply. Messaging frequency may vary. For more information on how your data will be handled, please visit our Privacy Policy.