Credit Application

Company Name

Business Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Contact Name

Position

Phone Number

Fax Number

E-mail

Website

Place of Incorporation

Date of Incorporation

- Month - Day Year

Has this business had previous names other than the name listed above?

Yes No

Please list them, separated by comma, here

Industry - Type of Business

Manufacturer

Contact

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Fax Number

E-mail

Website

Invoice / Quotation Amount

Amount of Financing required

Expected Date of Delivery

- Month - Day Year

Description of New machines(s) (Make/Model)

Purpose of the new machinery (Example: equipment replacement / production increase / new product line)

Where will new machinery be located?

	Name	Title	% Ownership
1
2
3
4
5

Have any of the officers or owners of the compnay been convicted of a felony?

Yes No

Have any of the officers of the company been involved in a bankruptcy?

Yes No

Are there any lawsuits pending against the company?

Yes No

Please attach an explanation regarding your response to the 3 previous questions

Bank Name

Branch #

Contact Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Insurance Company Name

Phone Number

Accountant / Auditor Name

Phone Number

Lawyer Name

Phone Number

List your Key Managers and Supervisors

	Name	Position	Industry Experience	Company Experience
1
2
3
4
5
6
7
8

Describe your business:

What size is your plant (please specify units)

Do you own or rent the plant and office?

Rent Own

How many Machines / Technology Systems are used in your company? (Please indicate brand)

What is your Company's annual production (please include units)

	Production
Annual Production
Estimated current fiscal year
Estimated next year

List your Major Products / Services

	Product / Service	% of Sales
1
2
3
4
5

Total Number of Clients

List your largest clients

	Client	Sales %	Customer Business Activity
1
2
3
4
5

Describe your sales terms with clients (i.e. 30, 45 days, etc.)

List your main supplier of raw materials

	Supplier	Payment Terms	% of Total Purchases
1
2
3
4
5

List your Working Capital Bank Lines:

	Bank	Amount Outstanding	Maximum Credit Limit
1
2
3
4
5

List your Long Term Debt Outstanding

	Bank	Amount Outstanding	Maximum Credit Limit	Final Maturity	# of Payments Per Year
1
2
3
4
5

Please enclose the following to the Credit Application

New Equipment Invoice/Quotation
Latest three (3) Fiscal Years Audited Financial Statements with Accounting Notes
Current Fiscal Year Interim Financial Statements
Two (2) year Income Statement Projections and Balance Sheet of the Company and/or Group
Organizational Chart of the company and/or group
Two (2) Bank References
Two (2) Trade References

Signature

Name

First Name Last Name

Title

Date

- Month - Day Year

Credit Information