Credit Application

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Credit Application

Date *
NAME OF COMPANY OR INDIVIDUAL *
Email *
FEDERAL ID #
RESALE ID #
TYPE OF BUSINESS: *(CORPORATION, PARTNERSHIP, INDIVIDUAL)
Years Established *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
BILLING ADDRESS
if different from above.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Mobile Number

Financial

Owner's Name and Phone Number *
Financial Officer Name and Phone Number
Purchasing Officer Name and Phone Number
Email of FINANCIAL or PURCHASING Officer
SALES TAX EXEMPT? *
YesNo
if Applicable: ATTACH COPY CERTIFICATE TO APPLICATION–EXEMPT#
Bank Name
Bank Phone
Checking Account #

PREFFERED METHOD TO RECEIVE BILLING INVOICES &STATEMENTS (PLEASE CHOOSE ONE)

Choose one
FAXINVOICES AND STATEMENTS TOEMAIL INVOICES AND STATEMENTS TO
BUSINESS OR TRADE REFERENCES
Please enter company name, city, state, tel/fax
Authorization *
By Checking this box, I authorize the release of account information to Blue Whale, Inc. Account balance is due and payable IN FULL by the end of the following month. A SERVICE CHARGE of 11% per month will be charged on all balances exceeding payment terms.Yes, I Agree

Verification

Please enter any two digits *Example: 12
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