Credit Application

Business Contact Information

Legal Company Name(required)

Billing Address(required)

City(required)

State(required)

Zip Code(required)

Billing Contact(required)

Phone(required)

Example: 432-563-3332

Zip Code(required)

Date Business Commenced(required)

Fax(required)

Example: 432-563-3340

Email address(required)

Owners / Officers

Name(required)

Title(required)

Social Security Number

Add Another Owner / Officer(required)

Name(required)

Title(required)

Social Security Number

Have you or any company you are affiliated with ever filed bankruptcy?(required)

Yes

No

If So, When?

What Chapter?

In What State/County?

Business and Credit Information

Primary Physical Business Address(required)

City(required)

How Long at Current Address(required)

Email address(required)

Federal ID #(required)

State(required)

Phone(required)

Example: 432-563-3332

Tax Exempt(required)

No

Yes

State Tax #(required)

Zip Code(required)

Fax(required)

Exampe: 432-563-3340

Upload Tax Exemption Certificate

*If so attach tax exemption certificate

DUNS #

Bank Information

Bank Name(required)

City(required)

Type of Account(required)

Savings

Checking

Other

Account Number(required)

Bank Address(required)

State(required)

Phone(required)

Zip Code(required)

Business / Trade References

Must have a minimum of three (3) references in order to process your credit application.

Business / Trade Reference #1

Company Name(required)

Address(required)

City(required)

State(required)

Zip Code(required)

Phone(required)

Fax(required)

Email(required)

Type of Account(required)

Business / Trade Reference #2

Company Name(required)

Address(required)

City(required)

State(required)

Zip Code(required)

Phone(required)

Fax(required)

Email address(required)

Type of Account(required)

Business / Trade Reference #3

Company Name(required)

Address(required)

City(required)

State(required)

Zip Code(required)

Phone(required)

Fax(required)

Email address(required)

Type of Account(required)

Information Required by your company on delivery tickets to ensure prompt payment:

Requested Credit Limit(required)

Agreement

All payments are due 30 days from the receipt of the invoice.
Interest charge of 18% per annum or 1.5% per month will be applied back to the past due date should your account be referred to collections and/or if other legal action is required to collect your past due account. This will be in addition to any collection and legal fees.
Invoicing disputes must be made in writing within 30 business days.
By submitting this application, you authorize Milford to make inquiries into the banking and business/trade references that you have supplied.
Annual CPA audited financial statements, or a personal guarantee MAY be required if after reviewing your credit application, bank and business trade references:
1. Your credit limit requested is higher than your trade references balance history.
2. Your bank and business trade references are insufficient.
3. Your business has been established less than 2 years, regardless of type of ownership.
Only an owner, officer, or a non-officer with written signatory authority signed by an owner or officer can sign. Proper certification must be presented at time of submission.
The individual/s signing this page hereby represent/s and warrant/s that s/he is duly authorized to execute and deliver this Agreement on behalf of (Legal Company Name) and that this Agreement is binding upon said company in accordance with its terms.

Do you agree(required)

Yes

No

If you have read the above statement, please check yes if you agree the agreement above.

E - Signatures

By typing my name in the following box I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing this credit application and its information.

The Individual that is signing this credit application MUST be an owner/officer of the company in order to complete this application.

Owner/Officer(required)

Job Title(required)

Date(required)

Comments

Credit Application

*Please note: if you receive a submission error, rest assured, we have received your credit application

Business Contact Information

Owners / Officers

Business and Credit Information

Bank Information

Business / Trade References

Business / Trade Reference #1

Business / Trade Reference #2

Business / Trade Reference #3

Products

Invoicing

Agreement

E - Signatures

Milford Companies

Recent News

Contact

Follow Milford

SEARCH