Business Credit Application

Thank you for your interest in establishing credit with Chadwick Service Company. In order to provide you with the best possible service, we ask that you complete this application for credit accurately and in its entirety.

IMPORTANT TO NOTE:

This application is not fully complete until a current financial statement is emailed to Accounting@ChadwickService.com.

Please note that if you are tax exempt, you must email your exemption certificate to Accounting@ChadwickService.com.

If you have not already done so, please complete the New Customer Information form.

Full Legal Company Name

Phone

(###)

###

####

Fax

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Customer Contact Name For Credit

First Name

Last Name

Customer Contact Title

Customer Contact Phone

(###)

###

####

Customer Contact Email

Entity Type

Corporation

Partnership

Proprietorship

LLC

Other

If other, please list

Federal ID #

DUNS #

Parent Company (if applicable)

Name of Principals or Partners

Primary Bank Name

Account #

Bank Contact Name

First Name

Last Name

Bank Contact Title

Bank Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Trade Reference #1 Name

First Name

Last Name

Trade Reference #1 Phone

(###)

###

####

Trade Reference #1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Trade Reference #1 Email

Trade Reference #2 Name

First Name

Last Name

Trade Reference #2 Phone

(###)

###

####

Trade Reference #2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Trade Reference #2 Email

Trade Reference #3 Name

First Name

Last Name

Trade Reference #3 Phone

(###)

###

####

Trade Reference #3 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Trade Reference #3 Email

In consideration of the granting of credit by Chadwick Service Company, I (we) agree to the following:

The information provided herein is true and correct and can be relied upon to provide credit

I (we) authorize Chadwick Service Company to make inquiries with bank and trade contracts and other resources

I (we) agree to pay all charges net 30 days from invoice date. I (we) also agree to pay finance charges at the rate of 1% per month on all overdue charges

I (we) agree to pay any collection fees incurred, including reasonable attorney fees

Date Completed

Company Name

Initials to Represent Signature of Signer

Name and Title of Signer

Business Credit Application

Choose your starting point

Chadwick Service Company