Credit Form - Bulk Solutions, Inc

Business Credit Application

We request your cooperation in completing and returning this form to as as soon as possible so that we can review your request for credit availability. Also, a COPY OF YOUR LATEST FINANCIAL STATEMENT maybe requested upon review.

Bulk Solutions, Inc.
4040 Waring Road, Lakeland, FL 33811
863-248-1136
COMPANY INFORMATION
Company Name*
Date
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone Number*
Business Fax Number
Email*
Organization Type*
- Public Corporation
- LLC
- Private Corporation
- Partnership
- Sole Proprietorship
- Government
- Other
Date Business Started*
MM
DD
YYYY
Federal Tax ID Number*
Type of Business*
D&B (DUNS) Number*
Accounts Payable Contact*
Phone Number*
OFFICERS & OWNERS
Name*
Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name*
Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name*
Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
BANK INFORMATION
Name*
Bank Contact Name
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Fax Number
TRADE REFERENCES
Company Name*
City/State*
Phone Number*
Fax Number
Company Name*
City/State*
Phone Number*
Fax Number
Company Name*
City/State*
Phone Number*
Fax Number
We certify that the above information is true and correct to the best of our information, knowledge, and belief. We agree to pay all charges according to the terms and conditions as slated by . ("Creditor") If we fail to do so, then we agree to pay any late charges, reasonable collection costs and attorney fees if collection procedures are instituted. Should credit availability be granted by Creditor, all decisions with respect to the extension or continuation of credit shall be at sole discretion of Creditor. Creditor may terminate any credit availability within its sole discretion.
We authorize you to conduct an investigation of our credit worthiness, including but not limited to securing commercial credit reports, consumer credit reports, trade references, lender references, lease references.
We hereby authorize release of credit information to:
Signature
Name*
First Last
Title*
Date*
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this creditor is the Federal Trade Commission.
Email
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Business Credit Application

COMPANY INFORMATION

OFFICERS & OWNERS

BANK INFORMATION

TRADE REFERENCES

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