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 agree and acknowledge that Action Lock Doc may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to Opt-out by replying “STOP”. For more information on how your data will be handled, please visit our Privacy Policy.