CTIconnect Credit Application

Credit Application for Net 30 Terms

Company Information
Company Name *
Phone Number *

Area Code Phone Number
Fax Number *

Area Code Phone Number
E-mail *
Company Shipping Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Company Type *

Sole Proprietorship Partnership Corporation Other
Business and Credit Info
Accounts Payable Contact *

First Name Last Name
Accounts Payable Phone *

Area Code Phone Number
Accounts Payable Fax

Area Code Phone Number
E-mail *
Company to Bill Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Bank Name *
Branch Name *
Branch Contact *
Bank Branch Phone Number *

Area Code Phone Number
Bank Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
General Information
Federal Tax ID # *
Dun & Bradstreet # *
If you none type n/a
Amount of Credit requested *
ex. $10,000
Are Purchase Orders Required? *

Yes No
Checking Acct. # *
Checking Acct. Routing # *
Savings Acct. # *
Savings Acct. Routing # *
Authorization to Release Confidential Information *

I/We authorize you our financial institution to release all information related to these accounts, accounts balances and activity to CTIconnect, LLC.
Authorization Signature *

Clear
Business References
Reference 1: Company Name *
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Fax Number

Area Code Phone Number
E-mail
Type of Account
Reference 2: Company Name *
Address 2

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number 2

Area Code Phone Number
Fax Number 2

Area Code Phone Number
Type of Account 2
Terms and Conditions

All accounts are Cash/COD/Wire/Credit Card until a credit application has been completed, reviewed and approved. If any indebtedness incurred pursuant to this request for credit is not paid in full when due, the undersigned agrees to pay all costs of collection, including a reasonable attorneys fee. Any balance so remaining unpaid shall bear interest at the lesser rate of 1.5% per month or the maximum rate permitted by applicable law, until paid in full.
Agreement and Terms *

All invoices are to be paid 30 days from the date of the invoice.
Agreement and Terms *

Claims arising from invoices must be made within 7 business days of the invoice date.
Agreement and Terms *

By submitting this credit application, indicates your acceptance of the terms and conditions as stated and terms of service listed at cticonnect.com. In addition, you authorize CTIconnect, LLC. To make any and all inquiries necessary to process this credit application.
Enter the word as it's shown *
Agreed and Accepted, Signed *

Clear
Today's Date *

Month Day Year
Date
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Credit Application for Net 30 Terms

Business and Credit Info

General Information

Business References

Terms and Conditions